NPI | 1447826672 |
---|---|
Former Name | ANGELA MARY BACON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL APRN11010798) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11010798) |
363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN11010798) | |
Enumeration Date | 2021-05-28 |
Last Update Date | 2025-09-17 |