Individual
TAMIKO LATIESE HODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OWNER
Contact information
Practice address
1425 MORNINGSIDE DR, LAKE WALES, FL 33853-3911
(863) 241-6590
Mailing address
1425 MORNINGSIDE DR, LAKE WALES, FL 33853-3911
(863) 241-6590
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
08/18/2022
Last updated
08/18/2022
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