Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 22280 | TN |
NPI | 1043425689 |
---|---|
Provider Name | Ms. Rebecca Ellen Flora-Waterman |
First Address | Bristol, TN 37620-1706 |
Second Address | Bristol, TN 37620-1706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 07/04/2017 |