Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA40986 | FL |
NPI | 1689878399 |
---|---|
Provider Name | Mrs. Tonya O'sullivan |
First Address | Sebring, FL 33870-2125 |
Second Address | Sebring, FL 33870-2125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2007 |
Last Update Date | 08/07/2007 |