Individual
DR. ANTOINETTE C DEFAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
6 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
(813) 844-3541
Mailing address
PO BOX 1289, TAMPA, FL 33601-1289
(813) 835-8069
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
1613
MD
103G00000X
Clinical Neuropsychologist
PY6666
FL
103T00000X
Psychologist
Primary
PY6666
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1613
PSYCHOLOGY LICENSE
MD
01
—
PY 6666
FLORIDA PSYCHOLOGY
FL
Enumeration date
11/01/2006
Last updated
07/08/2013
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