Organization
DEVEREUX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKY HERRICK M.A. (CLINICIAN)
(407) 963-7873
Entity
Organization
Contact information
Practice address
1010 EXECUTIVE CENTER DR, ORLANDO, FL 32803-3529
(407) 367-1665
Mailing address
5850 T G LEE BLVD, ORLANDO, FL 32822-4407
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
FL
Other
Enumeration date
08/16/2013
Last updated
08/16/2013
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