Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 9186925 | FL |
NPI | 1568800613 |
---|---|
Provider Name | Mrs. Sara Marie Preston |
First Address | Jacksonville, FL 32204-4763 |
Second Address | Jacksonville, FL 32204-4763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 30/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009945300 | (05) | FL |