Organization
ANISTA CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILL WELTER (CEO)
(813) 855-4555
Entity
Organization
Contact information
Practice address
10718 COUNTRYWAY BLVD, TAMPA, FL 33626-1733
(813) 855-4000
Mailing address
10718 COUNTRYWAY BLVD, TAMPA, FL 33626-1733
(813) 855-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME92268
FL
Other
Enumeration date
08/22/2011
Last updated
08/29/2011
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