Individual
ANNALISA TIETJEN I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
714 AVE C, FORT PIERCE, FL 32909
(772) 462-3800
(772) 462-3801
Mailing address
5150 NW MILNER DR, PORT SAINT LUCIE, FL 34983-3392
(772) 462-3800
(772) 462-3801
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH17092
FL
Other
Enumeration date
12/02/2014
Last updated
12/02/2014
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