Individual
MRS. MILDRED SNOW BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
6178 LAUREL LN, TAMARAC, FL 33319-8137
(754) 281-7588
Mailing address
6178 LAUREL LN, TAMARAC, FL 33319-8137
(754) 281-7588
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN917501
FL
Other
Enumeration date
10/09/2009
Last updated
10/09/2009
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