Doctor Name: | MRS. MARY THERESA FLOYD |
NPI Number: | 1134151475 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R47965 |
Business Practice Address: | 2050a 2nd St Se 377 Mdg Kirtland Afb, NM - 871175522 |
Business Phone Number: | 5052462450 |
Business Fax Number: | |
Mailing Address: | 2050 A Second St Se, 377 Mdg KIRTLAND AFB |
State: | NM |
Postal Code: | 871175522 |
Phone Number: | 9072462450 |
Fax Number: | |
NPI Enumeration Date: | 07/07/2006 |
NPI Last Update Date: | 09/10/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R47965 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |