Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | APRN11002943 | FL |
NPI | 1003473117 |
---|---|
Provider Name | Melanie A Daly |
First Address | Tampa, FL 33622-5317 |
Second Address | Orange Park, FL 32003-4821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2019 |
Last Update Date | 18/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103470500 | (05) | FL |
LK066 | MEDICARE (01) | FL |