Individual
LAQUANDA WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6355 27TH ST N, SAINT PETERSBURG, FL 33702-6395
(727) 667-2184
Mailing address
PO BOX 3392, PINELLAS PARK, FL 33780-3392
(727) 667-2184
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
05/11/2018
Last updated
05/11/2018
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