Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | APRN9264398 | FL |
NPI | 1043518756 |
---|---|
Provider Name | Tera Daniells Maple |
First Address | Jacksonville, FL 32216-3623 |
Second Address | Middleburg, FL 32068-8459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2011 |
Last Update Date | 30/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003126038A | (05) | GA |
006292300 | (05) | FL |