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General NPI Number Information
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NPI Number | 1043844202
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Entity Type | Individual
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Provider Name | ANNIE D ODOM
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Gender | Female
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Dates
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Enumeration Date | 02/26/2020
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 2257 CLARA KEE BLVD
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City | TALLAHASSEE
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State | FL
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Zip | 32303-7135
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Country | US
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Telephone | 850-405-0109
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Fax |
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Provider Business Mailing Address
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Address Line | 2413 RAYMOND DIEHL RD APT 2
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City | TALLAHASSEE
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State | FL
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Zip | 32309-3628
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Country | US
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Telephone | 850-692-4300
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Fax | 850-668-8329
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 115567
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 235755
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 115567
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License Number State | FL
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