Individual
FARRONDA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3230 SPICER AVE, GRAND ISLAND, FL 32735-9017
(352) 702-6360
Mailing address
3230 SPICER AVE, GRAND ISLAND, FL 32735-9017
(352) 702-6360
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005563700
—
FL
Enumeration date
10/21/2016
Last updated
10/21/2016
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