Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9319562 | FL |
NPI | 1003337726 |
---|---|
Provider Name | Ms. Lenette Blanco |
First Address | Pembroke Pines, FL 33029-3466 |
Second Address | Plantation, FL 33324-2703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 17/03/2018 |