Individual
TRACEY LANDRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 INTERNATIONAL PKWY, LAKE MARY, FL 32746-5035
(407) 732-5848
Mailing address
37 OCEAN BREEZE CIR, ORMOND BEACH, FL 32176-2821
(386) 290-7553
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OTA10905
FL
Other
Enumeration date
02/12/2010
Last updated
02/12/2010
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