Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2750402 | FL |
NPI | 1184028284 |
---|---|
Provider Name | Kimberly Porter |
First Address | Pensacola, FL 32534-1348 |
Second Address | Pensacola, FL 32504-8721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2014 |
Last Update Date | 29/01/2015 |