Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN17256 | FL |
N | 1223G0001X | General Practice | 17256 | FL |
N | 213EG0000X | General Practice | 17256 | FL |
NPI | 1063636710 |
---|---|
Provider Name | Mrs. Ericka Shelly Ferguson |
First Address | Apopka, FL 32703-5805 |
Second Address | Apopka, FL 32703-6080 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 18/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023026500 | (05) | FL |
076768900 | (05) | FL |