Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN11013314 | FL |
NPI | 1033782099 |
---|---|
Provider Name | Mara Lee Beebe |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Spring Hill, FL 34609-5696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 28/07/2021 |