Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PT34218 | FL |
NPI | 1033680848 |
---|---|
Provider Name | Priscilla Jaime |
First Address | Tampa, FL 33624-1853 |
Second Address | Tampa, FL 33606-1812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 06/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT34218 | LICENSE (01) | FL |