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Individual
ERRYN C PROVENCHER
Active
Individual
ERRYN C PROVENCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9112417
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2610
LICENSE
OK
Enumeration date
01/08/2016
Last updated
03/30/2023
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