Individual
ANGELA RUSSELL MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5 TAMPA GENERAL CIR STE 410, TAMPA, FL 33606-3578
(813) 844-7473
(813) 844-1966
Mailing address
PO BOX 1289, TAMPA, FL 33601-1289
(813) 844-7000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.005098
IL
363A00000X
Physician Assistant
Primary
PA9112371
FL
Other
Enumeration date
08/07/2014
Last updated
03/12/2020
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