Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | APRN11003908 | FL |
NPI | 1023667847 |
---|---|
Provider Name | Joel Luis Polanco |
First Address | Hialeah, FL 33014-1793 |
Second Address | Doral, FL 33172-2655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2019 |
Last Update Date | 04/09/2019 |