Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN11005132 | FL |
NPI | 1023654654 |
---|---|
Provider Name | Lyne Emilie Homeus |
First Address | Daytona Beach, FL 32117-4503 |
Second Address | Palm Coast, FL 32164-7631 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 09/01/2020 |