Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH5147 | FL |
NPI | 1306230180 |
---|---|
Provider Name | Jemma B Sinclaire |
First Address | Tampa, FL 33613-1263 |
Second Address | Tampa, FL 33613-1263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2015 |
Last Update Date | 19/03/2015 |