Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | ARNP 9290955 | FL |
NPI | 1093107526 |
---|---|
Provider Name | Laura Beth Pope |
First Address | Winter Garden, FL 34787-2457 |
Second Address | Jacksonville, FL 32207-8210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2015 |
Last Update Date | 26/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003158165A | (05) | GA |
014415700 | (05) | FL |