Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN11004625 | FL |
NPI | 1043853468 |
---|---|
Provider Name | Jennifer Nicole Conrad |
First Address | Cape Canaveral, FL 32920-5130 |
Second Address | Orlando, FL 32803-1248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2019 |
Last Update Date | 12/12/2019 |