Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 9174215 | FL |
NPI | 1033409032 |
---|---|
Provider Name | Loretta Bacchiocchi |
First Address | Orlando, FL 32803-5734 |
Second Address | Orlando, FL 32803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2011 |
Last Update Date | 24/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017737900 | (05) | FL |