Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 547140 | FL |
NPI | 1295844025 |
---|---|
Provider Name | Mary Magdalene Cortes |
First Address | Charlottesville, VA 22906-6250 |
Second Address | Altamonte Springs, FL 32714-5206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P93449 | (02) | FL |