MEDICARE: SPA BELIZIMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	080609	FL
2	261QP2300X	Primary Care Clinic/Center
3	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1174755631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPA BELIZIMA

Provider Business Mailing Address
First Line	:	7603 GUNN HWY STE D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-3164
Country	:	US
Telephone Number	:	813-751-5691
Fax Number	:	866-422-1671

Provider Business Practice Location Address
First Line	:	7603 GUNN HWY STE D
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-3164
Country	:	US
Telephone Number	:	813-751-5691
Fax Number	:	866-422-1671

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	ANN-MARIE SHERRY HARRIS-POLANCO
Credential	:	APRN
Telephone Number	:	813-751-5691

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	04/05/2023

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Directions to “SPA BELIZIMA ” Practice Location

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