Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ARNP 1523062 | FL |
NPI | 1083777155 |
---|---|
Provider Name | Mrs. Marguerite Mauradian |
First Address | Palm Harbor, FL 34683-4218 |
Second Address | Oldsmar, FL 34677-2962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S51419 | (02) | FL |