Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN9304621 | FL |
NPI | 1003366428 |
---|---|
Provider Name | Monica Anderson |
First Address | Winter Haven, FL 33880 |
Second Address | Haines City, FL 33844-6643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2016 |
Last Update Date | 12/08/2020 |