Organization
TAMPA BAY MED, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE SISKO (CREDENTIALING SPECIALIST)
(727) 483-7463
Entity
Organization
Contact information
Practice address
7500 4TH ST N, ST PETERSBURG, FL 33702-5400
(727) 798-0599
(727) 525-1835
Mailing address
311 PARK PLACE BLVD, 5TH FLOOR, CLEARWATER, FL 33759-4904
(727) 483-7463
(727) 755-0679
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME106734
FL
Other
Enumeration date
12/03/2015
Last updated
12/03/2015
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