Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | TRN14929 | FL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME126475 | FL |
NPI | 1134447030 |
---|---|
Provider Name | Marielle Ameli Amoli |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2010 |
Last Update Date | 03/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018556000 | (05) | FL |