Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME129708 | FL |
Y | 111NI0900X | Internist | ME129708 | FL |
NPI | 1003221938 |
---|---|
Provider Name | Joana Vicente Vargas |
First Address | Ocala, FL 34483-2017 |
Second Address | Ocala, FL 34471-8601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021459000 | (05) | FL |
9UYJJ | FLORIDA BLUE (01) | FL |