Individual
TAKITA LYSHAWN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
682 NE SAINT CLAIR ST, LAKE CITY, FL 32055-1719
(386) 623-5738
Mailing address
682 NE SAINT CLAIR ST, LAKE CITY, FL 32055-1719
(386) 623-5738
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
FL
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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