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Individual
IDA CENTINEO
Active
Individual
IDA CENTINEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1030675
TX
363LF0000X
Family Nurse Practitioner
26NJ01038600
NJ
363LF0000X
Family Nurse Practitioner
352903
NY
Other
Enumeration date
11/02/2019
Last updated
04/27/2026
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