Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | U04866 | FL |
Y | 111NI0900X | Internist | U04866 | FL |
NPI | 1003266396 |
---|---|
Provider Name | Nicole Baumgartner-Fernandez |
First Address | Largo, FL 33770-3133 |
Second Address | Largo, FL 33770-3133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2016 |
Last Update Date | 16/06/2016 |