Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 11012673 | FL |
NPI | 1023387933 |
---|---|
Provider Name | Sherry Roberts |
First Address | Winter Garden, FL 34787 |
Second Address | Winter Garden, FL 34787-9556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2011 |
Last Update Date | 23/04/2021 |