Individual
URSULA N NKWANTABISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1704 CARTIER PL, FORT WALTON BEACH, FL 32547-5730
(850) 687-7890
Mailing address
1704 CARTIER PL, FORT WALTON BEACH, FL 32547-5730
(850) 687-7890
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
235901
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
FL
Enumeration date
05/30/2019
Last updated
05/30/2019
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