Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1568070639 |
---|---|
Provider Name | Rebecca Ann Sumpter |
First Address | Eustis, FL 32726-3408 |
Second Address | Eustis, FL 32726-3408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2020 |
Last Update Date | 15/07/2020 |