Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 11006104 | FL |
NPI | 1023688017 |
---|---|
Provider Name | Karen R Elias Valladares |
First Address | Davenport, FL 33897-4642 |
Second Address | Davenport, FL 33897-4642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2021 |
Last Update Date | 30/06/2021 |