Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9197627 | FL |
NPI | 1003112137 |
---|---|
Provider Name | Latoya Wells |
First Address | Orlando, FL 32808-5646 |
Second Address | Orlando, FL 32808-5646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2011 |
Last Update Date | 08/02/2011 |