Organization
LICE AWAY TODAY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE CHERRY (MANAGING PARTNER)
(813) 410-4860
Entity
Organization
Contact information
Practice address
4308 W EL PRADO BLVD, TAMPA, FL 33629-8405
(813) 410-4860
Mailing address
4308 W EL PRADO BLVD, TAMPA, FL 33629-8405
(813) 410-4860
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
—
—
Other
Enumeration date
03/07/2017
Last updated
03/07/2017
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