Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME149410 | FL |
NPI | 1114360930 |
---|---|
Provider Name | Jordan Lupo Heath |
First Address | Gainesville, FL 32605-4582 |
Second Address | Gainesville, FL 32607-2822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 01/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111133800 | (05) | FL |