Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 14424 | PR |
Y | 208D00000X | General Practice Physician | ACN480 | FL |
NPI | 1003979006 |
---|---|
Provider Name | Miss Jeannette Marie Figueroa-Gordian |
First Address | Orlando, FL 32821-6027 |
Second Address | Tampa, FL 33614-7116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 25/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14424 | LICENSE (01) | PR |
ACN480 | MEDICAL LICENCE (01) | FL |