Individual
JOLENE JOLENE DE LA GARDELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPA
Contact information
Practice address
5510 N HESPERIDES ST, TAMPA, FL 33614-5414
(813) 467-6111
Mailing address
5510 N HESPERIDES ST, TAMPA, FL 33614-5414
(813) 467-6111
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
766798100
—
FL
Enumeration date
08/30/2006
Last updated
01/26/2024
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