Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO2913 | FL |
N | 213ES0131X | Foot Surgery | PO2913 | FL |
NPI | 1114964558 |
---|---|
Provider Name | Kristi Linn Conway |
First Address | Brandon, FL 33511-4887 |
Second Address | Brandon, FL 33511-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 03/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340208800 | (05) | FL |
U86854 | (02) | FL |