Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | PA9105278 | FL |
NPI | 1003847302 |
---|---|
Provider Name | Mrs. Andrea M Person |
First Address | Germantown, MD 20876-4070 |
Second Address | Fort Walton Beach, FL 32547-6708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 06/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
292457900 | (05) | FL |
PENDING | (02) | GA |