Individual
ETHEL LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12605 SANDPINE RESERVE PL, GIBSONTON, FL 33534-5553
(850) 597-4803
Mailing address
12605 SANDPINE RESERVE PL, GIBSONTON, FL 33534-5553
(850) 597-4803
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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