Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | ARNP1610792 | FL |
NPI | 1033178157 |
---|---|
Provider Name | Ms. Maud Evon Crosby |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2006 |
Last Update Date | 05/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S53220 | (02) | FL |