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Individual

CHRISANA LATAE SCOTT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2995 EAGLE NEST VIEW DR, WINTER HAVEN, FL 33881-3220
(863) 514-7501
Mailing address
2995 EAGLE NEST VIEW DR, WINTER HAVEN, FL 33881-3220
(863) 514-7501

Taxonomy

Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
101533400
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101533400
FL
Enumeration date
05/12/2020
Last updated
05/12/2020
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