Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | ARNP9329072 | FL |
NPI | 1073057550 |
---|---|
Provider Name | Ms. Suzelle Gauthier |
First Address | Lake Worth, FL 33467-6244 |
Second Address | Lake Worth, FL 33467-6244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2016 |
Last Update Date | 19/12/2016 |