Individual
GAETJENS TARDELLIE JOSEPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
901 45TH ST, MANGONIA PARK, FL 33407-2413
(561) 844-6300
Mailing address
901 45TH ST, MANGONIA PARK, FL 33407-2413
(561) 844-6300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
.
FL
Other
Enumeration date
02/21/2024
Last updated
02/21/2024
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