MEDICARE: IMANI TATE

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1740098490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMANI TATE

Provider Business Mailing Address
First Line	:	19046 BRUCE B DOWNS BLVD STE B6
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2434
Country	:	US
Telephone Number	:	813-586-0562
Fax Number	:

Provider Business Practice Location Address
First Line	:	14501 AUDUBON TRCE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-5410
Country	:	US
Telephone Number	:	813-586-0562
Fax Number	:

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

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	12/27/2024

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Directions to “ IMANI TATE ” Practice Location

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