Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5346264061 | KS |
NPI | 1265860142 |
---|---|
Provider Name | Kristen Fotopoulos |
First Address | Tampa, FL 33626-2509 |
Second Address | Tampa, FL 33626-2509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2013 |
Last Update Date | 31/10/2013 |