Individual
SHARLENE RHAETTA HUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
520 E 9TH ST, PANAMA CITY, FL 32401-2968
(850) 763-6250
Mailing address
520 E 9TH ST, PANAMA CITY, FL 32401-2968
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
680661996
—
FL
05
—
680661998
—
FL
Enumeration date
12/20/2010
Last updated
12/20/2010
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