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Individual

ANNE MARIE HERARD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2309 W CLINTON ST, TAMPA, FL 33604-5208
(813) 770-8739
Mailing address
2309 W CLINTON ST, TAMPA, FL 33604-5208
(813) 770-8739

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
691283496
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
691283496
FL
Enumeration date
02/26/2013
Last updated
02/26/2013
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