Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | ARNP1838862 | FL |
NPI | 1003865189 |
---|---|
Provider Name | Korean Ann Botts |
First Address | North Fort Myers, FL 33903-2817 |
Second Address | Clearwater, FL 33765-2364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S70407 | (02) | FL |
Y008Q | BCBS (01) | FL |