Individual
TANDELA SHAYONTAYE BLOUNT-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 ELLINGTON ST, PERRY, FL 32348-5200
(850) 672-2628
Mailing address
120 ELLINGTON ST, PERRY, FL 32348-5200
(850) 672-2628
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
01/11/2024
Last updated
01/11/2024
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