Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Gerontology
Enumerated
Oct 1, 2024
License(s)
APRN11036101 (FL), RN9432684 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 102222 | Atlanta, GA 30368-2222 | 239-274-8200 |
| LOCATION | 40215 HIGHWAY 27 | Davenport, FL 33837-7813 | 863-421-9705 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.