Individual
TENNILLE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
805 S KIRKMAN RD, 205, ORLANDO, FL 32811-2200
(407) 245-0012
Mailing address
805 S KIRKMAN RD, 205, ORLANDO, FL 32811-2200
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
MH14647
FL
Other
Enumeration date
04/05/2017
Last updated
04/13/2017
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