Individual
JUDITH RANELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 974-2583
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
ME54506
FL
208000000X
Pediatrics Physician
Primary
ME54506
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049662600
—
FL
01
—
07961
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/09/2006
Last updated
10/19/2020
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