Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | ME54506 | FL |
Y | 208000000X | Pediatrician | ME54506 | FL |
NPI | 1285644278 |
---|---|
Provider Name | Judith Ranells |
First Address | Orlando, FL 32891-7770 |
Second Address | Tampa, FL 33612-4742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 19/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049662600 | (05) | FL |
07961 | BLUE CROSS BLUE SHIELD (01) | FL |
C67928 | (02) | FL |