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Provider Information for 1619140852

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

DR. ANANTHI JEYABARATH MD

Gender: FEMALE

Individual NPI: 1619140852

Calendar   Last Updated:  2020-03-05
  Certification Date:  2020-03-05

Details

Name Value
NPI 1619140852
Enumeration Date 2008-04-09
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 270 MAIN ST N STE 300
STILLWATER, MN 55082-6788
United States

Phone: 651-342-1039 | Fax: 651-342-1428
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Primary Practice Address 10150 HIGHLAND MANOR DR STE 240
TAMPA, FL 33610
United States

Phone: 813-259-1013 | Fax:
View Map External Link
Secondary Practice Address 605 LAMAR AVE
BROOKSVILLE, FL 34601-3211
United States

Phone: 352-799-5411 | Fax: 352-544-2713
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605 LAMAR AVE
BROOKSVILLE, FL 34601-3211
United States

Phone: 352-799-5411 | Fax: 352-544-2713
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other BC/BS FLORIDA 53484
MEDICAID FL 270422600
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207R00000X - Internal Medicine FL ME84095