Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003408089 |
---|---|
Provider Name | Mrs. Faith Panganiban |
First Address | Jacksonville, FL 32256-7420 |
Second Address | Jacksonville, FL 32256-7420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2021 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ISW12725 | FL PROFESSIONAL LICENSE (01) | FL |