Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | OS12611 | FL |
NPI | 1801208764 |
---|---|
Provider Name | Maria Farrell |
First Address | Fort Lauderdale, FL 33309-3750 |
Second Address | Fort Lauderdale, FL 33316-2521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 25/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017538000 | (05) | FL |