Individual
JUDITH BARRET DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3988 HAMPTON HILLS DR, LAKELAND, FL 33810-3841
(863) 868-8758
Mailing address
3988 HAMPTON HILLS DR, LAKELAND, FL 33810-3841
(863) 868-8758
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906660
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011674100
—
FL
Enumeration date
09/23/2014
Last updated
09/23/2014
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