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Provider Information for 1679853345

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: 1679853345

Calendar   Last Updated:  2019-04-19
  Certification Date: 


Name Value
NPI 1679853345
Enumeration Date 2011-08-25
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2025 INDIAN ROCKS RD S
LARGO, FL 33774-1035
United States

Phone: 727-586-7103 | Fax: 727-585-7205
View Map External Link
Primary Practice Address 3600 OAK MANOR LN APT 46
LARGO, FL 33774-1214
United States

Phone: 727-489-3305 | Fax: 727-499-9559
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 207R00000X - Internal Medicine FL UO2813