Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 701927 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9173689 | FL |
NPI | 1003960295 |
---|---|
Provider Name | Judy Humphreys |
First Address | Fort Myers, FL 33901-9342 |
Second Address | Venice, FL 34237-9026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 26/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
198164902 | (05) | TX |
198164903 | (05) | TX |