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Individual

CATHERINE RE'NAE ODOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP-BC, FNP

Contact information

Practice address
13500 SUTTON PARK DRIVE SOUTH, SUITE 403, JACKSONVILLE, FL 32224-5291
(904) 493-3390
(904) 493-3395
Mailing address
13500 SUTTON PARK DRIVE SOUTH, SUITE 403, JACKSONVILLE, FL 32224-5291
(904) 493-3390
(904) 493-3395

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ARNP9190635
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
45681
MEDICARE - GROUP
FL
01
GW733Y
MEDICARE - INDIVIDUAL
FL
01
Y0FX6
FLORIDA BLUE
FL
Enumeration date
12/20/2012
Last updated
04/10/2013
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