Individual
FELICIA RENEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1422 MOONLITE DR, LAKELAND, FL 33801-7066
(863) 709-7389
Mailing address
PO BOX 502, AUBURNDALE, FL 33823-0502
(863) 709-7389
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
237515
FL
Other
Enumeration date
06/21/2022
Last updated
06/21/2022
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