Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 11007715 | FL |
NPI | 1023605441 |
---|---|
Provider Name | Ms. Jean Ching |
First Address | Trinity, FL 34655-1782 |
Second Address | Trinity, FL 34655-1782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2020 |
Last Update Date | 31/12/2020 |