Individual
MS. TANGELY MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COMMUNITY BASED
Contact information
Practice address
13 MONROE CREEK DR, MIDWAY, FL 32343-2212
(850) 570-6551
Mailing address
13 MONROE CREEK DR, MIDWAY, FL 32343-2212
(850) 570-6551
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021165900
—
FL
Enumeration date
09/21/2018
Last updated
09/21/2018
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