Skip Navigation

Provider Information for 1437109477

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: 1437109477

Calendar   Last Updated:  2020-01-15
  Certification Date:  2020-01-15


Name Value
NPI 1437109477
Enumeration Date 2006-05-11
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address PO BOX 82969
TAMPA, FL 33682-2969
United States

Phone: 813-866-0930 | Fax: 813-866-0929
View Map External Link
Primary Practice Address 4620 N 22ND ST
TAMPA, FL 33610-6205
United States

Phone: 813-272-6240 | Fax: 813-866-0929
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID FL 264162300
Primary Taxonomy Selected Taxonomy State License Number
Yes 207R00000X - Internal Medicine FL ME81640