Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 022175 | PR |
Y | 208D00000X | General Practice Physician | ACN1377 | FL |
NPI | 1003407172 |
---|---|
Provider Name | Toribio Mercedes Encarnacion |
First Address | Spring Hill, FL 34606-3833 |
Second Address | Spring Hill, FL 34606-4562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2021 |
Last Update Date | 15/09/2021 |