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Provider Information for 1982993176

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: 1982993176

Calendar   Last Updated:  2019-10-06
  Certification Date: 


Name Value
NPI 1982993176
Enumeration Date 2011-03-29
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 4301 NARVAREZ WAY S
ST PETERSBURG, FL 33712-4040
United States

Phone: 727-482-9170 | Fax:
View Map External Link
Primary Practice Address 5771 ROOSEVELT BLVD
CLEARWATER, FL 33760-3407
United States

Phone: 727-748-6649 | Fax: 727-523-3251
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 363LA2200X - Nurse Practitioner Adult Health FL APRN9306972