Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 11007760 | FL |
NPI | 1386260487 |
---|---|
Provider Name | Sarah Marie Anderson |
First Address | Tallahassee, FL 32305-1904 |
Second Address | Tallahassee, FL 32308-5352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2020 |
Last Update Date | 24/06/2020 |