Individual
IMMACULA AUGUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5711 N NEBRASKA AVE, TAMPA, FL 33604-7125
(813) 270-1013
(813) 512-8926
Mailing address
5711 N NEBRASKA AVE, TAMPA, FL 33604-7125
(813) 270-1013
(813) 512-8926
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
A223-400-70-803-1
FL
Other
Enumeration date
02/19/2018
Last updated
06/16/2018
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