Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH10530 | FL |
NPI | 1003577230 |
---|---|
Provider Name | Maritza Blackshaw |
First Address | Tampa, FL 33614-2409 |
Second Address | Tampa, FL 33614-2409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2022 |
Last Update Date | 10/01/2022 |