Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 9310888 | FL |
NPI | 1003391681 |
---|---|
Provider Name | Mrs. Sonia Burns |
First Address | Orange Park, FL 32065-5630 |
Second Address | Gainesville, FL 32606-9278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2018 |
Last Update Date | 22/08/2019 |