Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9293487 | FL |
NPI | 1003118779 |
---|---|
Provider Name | Suzanne Marie Boyd |
First Address | Medley, FL 33178-1175 |
Second Address | Miami, FL 33155-4071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2010 |
Last Update Date | 01/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004674500 | (05) | FL |