Healthcare Provider Details

I. General information

NPI: 1700360054
Provider Name (Legal Business Name): BIBITA PETER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2018
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 E MAIN ST
BARTOW FL
33830-5006
US

IV. Provider business mailing address

2610 QUEEN ALBERTA DR
VALRICO FL
33596-6526
US

V. Phone/Fax

Practice location:
  • Phone: 863-534-3737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME170192
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME170192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: