Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME0048792 | FL |
NPI | 1023440260 |
---|---|
Provider Name | Mildred Veronica Farmer |
First Address | St Petersburg, FL 33704-4836 |
Second Address | Brooksville, FL 34601-8910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2013 |
Last Update Date | 30/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1578777694 | NPI (01) | FL |
D51116 | (02) | FL |