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Individual

TAJSHMA TAGAYLA PETERSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
315 NE 10TH AVE, CRYSTAL RIVER, FL 34429-4456
(352) 795-7006
Mailing address
204 PLEASANT GROVE RD, INVERNESS, FL 34452-4414
(727) 667-4993

Taxonomy

Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary

Other

Enumeration date
10/18/2021
Last updated
10/18/2021
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