Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN230378 | MA |
N | 363LC1500X | Nurse Practitioner - Community Health | 11002027 | FL |
NPI | 1306485396 |
---|---|
Provider Name | Valli Jo Flynn |
First Address | Vero Beach, FL 32960-3383 |
Second Address | Vero Beach, FL 32960-3383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2019 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11002027 | APRN LICENSE (01) | FL |