Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 9430045 | FL |
NPI | 1003265679 |
---|---|
Provider Name | Mark Sipe |
First Address | Boca Raton, FL 33431-5507 |
Second Address | Delray Beach, FL 33484-6502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2016 |
Last Update Date | 16/09/2016 |