Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH21985 | FL |
NPI | 1073866679 |
---|---|
Provider Name | Miss Aubrie Leigh Tanner |
First Address | Jacksonville, FL 32256-7514 |
Second Address | Jacksonville, FL 32256-7514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2012 |
Last Update Date | 19/10/2012 |