Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | APRN11006623 | FL |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN11006623 | FL |
NPI | 1023639101 |
---|---|
Provider Name | Sandra Vigo |
First Address | Largo, FL 33770-3199 |
Second Address | Largo, FL 33770-3133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2020 |
Last Update Date | 27/01/2021 |