SAN THAWALANTHANNE

LONGWOOD, FL
NPI1275397622
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: FL  11031100)
Enumeration Date2024-02-07
Last Update Date2024-08-08
Business Address
SAN THAWALANTHANNE
2290 N RONALD REAGAN BLVD STE 116
LONGWOOD, FL 32750-3534
Phone number: 407-215-0095
Mailing Address
SAN THAWALANTHANNE
1000 S LAKE DR
CLEARWATER, FL 33756-4415
Phone number: 815-451-2897
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