Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 11005038 | FL |
NPI | 1083250781 |
---|---|
Provider Name | Maitte Garcia-Luis |
First Address | Hialeah, FL 33018-4269 |
Second Address | Hialeah, FL 33018-4269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2019 |
Last Update Date | 18/11/2019 |