Individual
MISS TAMMY-LEE CONNOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2449 SW VARDON ST, PORT ST LUCIE, FL 34953-2445
(772) 453-1458
Mailing address
2449 SW VARDON ST, PORT ST LUCIE, FL 34953-2445
(772) 453-1458
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
247200000X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247200000X
—
FL
Enumeration date
04/18/2017
Last updated
04/18/2017
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