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NPI Code Detail

MEDICARE: DR. TAMARA-KAY ALEXIS TIBBY D.M.D., M.P.H.

MEDICARE: DR. TAMARA-KAY ALEXIS TIBBY D.M.D., M.P.H.
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
11223P0221XPediatric DentistryDN15880FL
21223G0001XGeneral Practice DentistryDN15880FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508893850
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TAMARA-KAY ALEXIS TIBBY D.M.D., M.P.H.
Provider Business Mailing Address
First Line : 7728 PALM RIVER RD
Second Line :
City : TAMPA
State : FL
Zip : 33619-4215
Country : US
Telephone Number : 813-630-3637
Fax Number :
Provider Business Practice Location Address
First Line : 302 W FLETCHER AVE
Second Line :
City : TAMPA
State : FL
Zip : 33612-3415
Country : US
Telephone Number : 813-866-0930
Fax Number : 813-405-3722
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2006
Last Update Date : 11/19/2019

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