Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME129477 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | 25MA08752600 | NJ |
NPI | 1194028472 |
---|---|
Provider Name | Nicolas Su-Young Erbrich |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Orlando, FL 32827-7402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2010 |
Last Update Date | 13/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019471700 | (05) | FL |