Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN11016497 | FL |
NPI | 1003575523 |
---|---|
Provider Name | Mutinta Yvonne Tembo |
First Address | New Port Richey, FL 34655-1810 |
Second Address | New Port Richey, FL 34655-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2021 |
Last Update Date | 20/01/2022 |