Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME0064731 | FL |
NPI | 1104833524 |
---|---|
Provider Name | Mark A Giovanini |
First Address | Pensacola, FL 32514-5485 |
Second Address | Pensacola, FL 32514-5485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 12/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
259917100 | (05) | FL |
G93586 | (02) | FL |