MEDICARE: NIEBLES AND SAMTER MDS P.A

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	208000000X	Pediatrics Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1568500635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIEBLES AND SAMTER MDS P.A

Provider Business Mailing Address
First Line	:	10549 NORTH FLORIDA AVENUE
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33612
Country	:	US
Telephone Number	:	813-971-3844
Fax Number	:	813-971-3300

Provider Business Practice Location Address
First Line	:	10549 NORTH FLORIDA AVENUE
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33612
Country	:	US
Telephone Number	:	813-971-3844
Fax Number	:	813-971-3300

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACQUELINE MARIA NIEBLES
Credential	:	M.D
Telephone Number	:	813-971-3844

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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