Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APRN11009003 | FL |
NPI | 1033729959 |
---|---|
Provider Name | Ms. Juliet N/a Shaw |
First Address | Pembroke Pines, FL 33024-4545 |
Second Address | North Miami Beach, FL 33169-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2020 |
Last Update Date | 15/09/2020 |