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NPI Code Detail

MEDICARE: NATSUKO MODEN PA-C

MEDICARE: NATSUKO MODEN PA-C
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1255135430
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATSUKO MODEN PA-C
Provider Business Mailing Address
First Line : 3250 ZEMKE AVE
Second Line :
City : TAMPA
State : FL
Zip : 33621-5023
Country : US
Telephone Number : 813-828-2273
Fax Number :
Provider Business Practice Location Address
First Line : 3250 ZEMKE AVE
Second Line :
City : TAMPA
State : FL
Zip : 33621-5023
Country : US
Telephone Number : 813-828-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2025
Last Update Date : 03/17/2026

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Directions to “ NATSUKO MODEN PA-C” Practice Location

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