Individual
MS. TAMMY LEE DERITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1135
(352) 374-6047
Mailing address
2449 BROOK PARK WAY, JACKSONVILLE, FL 32246-9334
(904) 551-2373
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
23965
WV
Other
Enumeration date
05/07/2007
Last updated
07/08/2007
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