Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 2116592 | FL |
NPI | 1679687537 |
---|---|
Provider Name | Ms. Hyacinth Elaine Grey |
First Address | Cutler Bay, FL 33190-1003 |
Second Address | Cutler Bay, FL 33190-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 25/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
305892100 | (05) | FL |
U-PIN Q0558 | (02) | FL |