Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | ARNP 9220087 | FL |
NPI | 1043500945 |
---|---|
Provider Name | Mrs. Matilda Jansen |
First Address | Pensacola, FL 32513-2699 |
Second Address | Pensacola, FL 32504-8785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 10/01/2012 |