Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0266A | AZ |
Y | 213ES0000X | Sports Medicine | 0266A | AZ |
NPI | 1174050058 |
---|---|
Provider Name | Ms. Jill Floryance |
First Address | Tucson, AZ 85715-5825 |
Second Address | Tucson, AZ 85704-5727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 22/05/2017 |