Individual
LARA M WITTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3000 MEDICAL PARK DR STE 510, TAMPA, FL 33613-6602
(813) 615-7725
(813) 615-7082
Mailing address
13067 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0926
(813) 779-6303
(786) 868-0012
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
ME125433
FL
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
ME125433
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018286300
—
FL
01
—
PJWDL
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/29/2006
Last updated
03/18/2024
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