Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | APRN11003307 | FL |
N | 363LG0600X | Nurse Practitioner - Gerontology | APRN11003307 | FL |
NPI | 1003469560 |
---|---|
Provider Name | Miss Audrey Wong |
First Address | Orlando, FL 32803-1248 |
Second Address | Orlando, FL 32803-1248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2019 |
Last Update Date | 20/03/2020 |