Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME1152119 | FL |
NPI | 1043456148 |
---|---|
Provider Name | Rachna A Krish |
First Address | Jacksonville, FL 32258-5212 |
Second Address | Jacksonville, FL 32258-5212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2008 |
Last Update Date | 02/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010557300 | (05) | FL |
03344456 | (05) | NY |