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Provider Information for 1245230259

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1245230259

Calendar   Last Updated:  2021-06-25
  Certification Date:  2021-06-04


Name Value
NPI 1245230259
Enumeration Date 2005-08-01
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 4125 W PINE RIDGE BLVD
BEVERLY HILLS, FL 34465-8918
United States

Phone: 352-228-5200 | Fax:
View Map External Link
Primary Practice Address 3000 MEDICAL PARK DR STE 450
TAMPA, FL 33613-4681
United States

Phone: 813-972-5420 | Fax: 813-977-2021
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 208D00000X - General Practice FL ACN703
No 173000000X - Legal Medicine PR 9757
No 208D00000X - General Practice PR 9757