Individual
ANNALISA KATHLEEN DERRYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5021 NW 34TH ST STE C, GAINESVILLE, FL 32605-1191
(352) 377-3322
Mailing address
1001 SW 16TH AVE, APT 92, GAINESVILLE, FL 32601-8465
(352) 371-4968
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA43061
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C4130
BCBSF PROVIDER
FL
Enumeration date
05/08/2007
Last updated
07/08/2007
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