Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ARNP 241952 | FL |
NPI | 1033174750 |
---|---|
Provider Name | Joan Burritt |
First Address | Melbourne, FL 32901 |
Second Address | Melbourne, FL 32901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 29/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
303126800 | (05) | FL |
S77555 | (02) |