Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN10215 | FL |
NPI | 1548346877 |
---|---|
Provider Name | Patricia Susan Cook |
First Address | Arcadia, FL 34266 |
Second Address | Arcadia, FL 34266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2006 |
Last Update Date | 19/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
076092700 | (05) | FL |