Individual
MS. SALLY LOU WHITWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
135 E. FIRST STREET, LAKELAND, FL 33805-4609
(863) 686-2728
(863) 686-6737
Mailing address
P.O. BOX 91988, LAKELAND, FL 33804-1988
(863) 686-2728
(863) 686-6737
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9106097
FL
Other
Enumeration date
10/06/2011
Last updated
10/06/2011
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