Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 9411338 | FL |
NPI | 1003366949 |
---|---|
Provider Name | Tiffany Kristine Lamarca |
First Address | Englewood, FL 34223-1749 |
Second Address | Englewood, FL 34223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2016 |
Last Update Date | 10/08/2018 |