Individual
LAIZA SOUZA TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
500 E ROLLINS ST, ORLANDO, FL 32803
(855) 724-5411
Mailing address
140 MANDOLIN DR, WINTER HAVEN, FL 33884-3580
(727) 710-4072
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Enumeration date
04/27/2020
Last updated
04/27/2020
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