Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | ARNP9198078 | FL |
NPI | 1013256585 |
---|---|
Provider Name | Mary Wright |
First Address | Palm Harbor, FL 34685-1164 |
Second Address | Tampa, FL 33607-5860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2013 |
Last Update Date | 04/02/2013 |