Registry details
Type
Individual
Primary specialty
Nurse Practitioner
Enumerated
Oct 7, 2020
License(s)
729291 (NY), 357933 (NY)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 7751 BELFORT PKWY STE 120 | Jacksonville, FL 32256-6921 | 904-372-3943 |
| LOCATION | 50 NEW YORK AVE # 25A | Smithtown, NY 11787-3448 | 904-372-3943 |
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