Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH10361 | FL |
NPI | 1043631435 |
---|---|
Provider Name | Miss Shelly Anthony |
First Address | Jacksonville, FL 32204-2410 |
Second Address | Jacksonville, FL 32204-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2014 |
Last Update Date | 02/01/2014 |