Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ARNP 2839572 | FL |
NPI | 1053707992 |
---|---|
Provider Name | Vivian W. Endaya |
First Address | New Port Richey, FL 34655-5720 |
Second Address | New Port Richey, FL 34655-5720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 07/04/2015 |