Individual
ANNIE D ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2257 CLARA KEE BLVD, TALLAHASSEE, FL 32303-7135
(850) 405-0109
Mailing address
2413 RAYMOND DIEHL RD APT 2, TALLAHASSEE, FL 32309-3628
(850) 692-4300
(850) 668-8329
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
115567
FL
374U00000X
Home Health Aide
Primary
115567
FL
376J00000X
Homemaker
235755
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
012409200
—
FL
05
—
115567
—
FL
05
—
39970618
—
FL
Enumeration date
02/26/2020
Last updated
07/10/2023
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