Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2154002 | FL |
NPI | 1003356916 |
---|---|
Provider Name | Ramona Loutos |
First Address | Port St Lucie, FL 34952-5815 |
Second Address | Port St Lucie, FL 34952-5815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2017 |
Last Update Date | 27/02/2017 |