Individual
NATA CISSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7050 GALL BLVD, ZEPHYRHILLS, FL 33541-1347
(813) 788-0411
Mailing address
3015 N ROCKY POINT DR E UNIT 408, TAMPA, FL 33607-6084
(327) 253-7168
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
162132
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2019
Last updated
06/07/2023
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