Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY6800 | FL |
Y | 103T00000X | Psychologist | PY6800 | FL |
NPI | 1003841404 |
---|---|
Provider Name | Kristine Donovan |
First Address | Orlando, FL 32891-7770 |
Second Address | Tampa, FL 33612-9416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 28/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
73092 | BLUE CROSS BLUE SHIELD (01) | FL |