Individual
MENA ISNASSUOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
(813) 821-8038
(813) 974-4325
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 821-8038
(813) 974-4325
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME156171
FL
207Q00000X
Family Medicine Physician
4301115585
MI
207RP1001X
Pulmonary Disease Physician
Primary
ME156171
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115344800
—
FL
01
—
HMX8N
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/02/2014
Last updated
04/03/2024
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