Individual
IVANNA REBECCA PENGELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2110 S GADSDEN ST, TALLAHASSEE, FL 32301-5513
(561) 309-9746
Mailing address
2110 S GADSDEN ST, TALLAHASSEE, FL 32301-5513
(561) 309-9746
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/12/2019
Last updated
07/12/2019
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