Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN9251941 | FL |
N | 363LA2200X | Nurse Practitioner - Adult Health | ARNP9251941 | FL |
N | 363LP2300X | Nurse Practitioner - Primary Care | ARNP9251941 | FL |
NPI | 1073033676 |
---|---|
Provider Name | Mrs. Sally Ann Robertson |
First Address | Temple Terrace, FL 33637-0904 |
Second Address | Temple Terrace, FL 33637-0904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2017 |
Last Update Date | 23/09/2020 |