Individual
KENOSHA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1827 AURBURN ST S, ST. PETE, FL 33701
(727) 831-9111
Mailing address
1827 AURBURN ST S, ST. PETE, FL 33701
(727) 831-9111
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A536512828870
—
FL
Enumeration date
04/07/2021
Last updated
04/07/2021
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