Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | APRN9337772 | FL |
NPI | 1649748880 |
---|---|
Provider Name | Mrs. Amanda Cook |
First Address | Orlando, FL 32891-0001 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2018 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101481400 | (05) | FL |
KM240 | MEDICARE (01) | FL |
VHC51 | BLUE CROSS BLUE SHIELD (01) | FL |