Individual
RENEE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10924 MILITARY TRL, TALLAHASSEE, FL 32305-2515
(850) 421-0064
Mailing address
10924 MILITARY TRL, TALLAHASSEE, FL 32305-2515
(850) 421-0064
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
02B08871
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230035400
—
FL
Enumeration date
05/08/2008
Last updated
05/08/2008
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