Individual
MRS. MARY SOUTHWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2601 CAMPUS HILL DR, TAMPA, FL 33612-4722
(813) 978-8203
(813) 978-8203
Mailing address
1472 LAKE SHORE RANCH DR, SEFFNER, FL 33584-5562
(813) 503-2441
(813) 978-8203
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015721500
—
FL
Enumeration date
01/07/2016
Last updated
01/07/2016
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