Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 11001385 | FL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 11001385 | FL |
NPI | 1003371642 |
---|---|
Provider Name | Mrs. Amber Jane Siegel |
First Address | Orlando, FL 32819-9003 |
Second Address | Orlando, FL 32819-9003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2019 |
Last Update Date | 24/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104856000 | (05) | FL |
11001385 | I DO NOT HAVE ANY OTHER NUMBER (01) |