NPI | 1942709217 |
---|---|
Former Name | JENNA NICHOLE MAYFIELD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9115138) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3516) |
Enumeration Date | 2018-02-01 |
Last Update Date | 2022-03-10 |