Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F336925 | NY |
NPI | 1003183112 |
---|---|
Provider Name | Ms. Marina Pavlovic |
First Address | Floral Park, NY 11001-3429 |
Second Address | Mineola, NY 11501-4064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2011 |
Last Update Date | 28/09/2012 |