Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | ME104856 | FL |
Y | 207RX0202X | Medical Oncology | ME104856 | FL |
NPI | 1316041064 |
---|---|
Provider Name | Jennifer Lyn Cultrera |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Lady Lake, FL 32159-8975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000971000 | (05) | FL |