MEDICARE: LICET RAMOS GALVEZ

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	363LF0000X	Family Nurse Practitioner	11034720	FL

General Provider Information

NPI Number	:	1356162655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LICET RAMOS GALVEZ

Provider Business Mailing Address
First Line	:	4311 W WATERS AVE STE 304B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1901
Country	:	US
Telephone Number	:	813-400-2201
Fax Number	:	813-212-5230

Provider Business Practice Location Address
First Line	:	4311 W WATERS AVE STE 304B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1901
Country	:	US
Telephone Number	:	813-400-2201
Fax Number	:	813-212-5230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	04/07/2026

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Directions to “ LICET RAMOS GALVEZ ” Practice Location

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