Individual
MRS. LARNETTA RENNE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4050 CENTRAL AVE, SAINT PETERSBURG, FL 33711-1239
(727) 327-7656
(727) 322-2130
Mailing address
PO BOX 10970, SAINT PETERSBURG, FL 33733-0970
(727) 327-7656
(727) 322-2130
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
FL
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060381300
—
FL
Enumeration date
03/20/2012
Last updated
12/22/2022
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