Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | ARNP9272743 | FL |
NPI | 1013382126 |
---|---|
Provider Name | Knetra Hatch |
First Address | Temple Terrace, FL 33637-7923 |
Second Address | Tampa, FL 33605-3512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2015 |
Last Update Date | 01/12/2015 |