Individual
TABATHA DEGRAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CLC
Contact information
Practice address
721 SW 60TH AVE, PLANTATION, FL 33317-3931
(954) 804-4904
Mailing address
721 SW 60TH AVE, PLANTATION, FL 33317-3931
(954) 804-4904
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
336808
FL
Other
Enumeration date
03/28/2022
Last updated
03/28/2022
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