Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 12392 | TN |
NPI | 1003969627 |
---|---|
Provider Name | Mr. Mike J Primeaux |
First Address | Jacksonville, FL 32257-8203 |
Second Address | Jacksonville, FL 32257-8203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 17/03/2018 |