Healthcare Provider Details

I. General information

NPI: 1346779451
Provider Name (Legal Business Name): PRISCILLA RIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 OAKFIELD DRIVE STE 134
BRANDON FL
33511
US

IV. Provider business mailing address

8309 N ORLEANS AVE
TAMPA FL
33604-2824
US

V. Phone/Fax

Practice location:
  • Phone: 813-489-4547
  • Fax: 813-381-5140
Mailing address:
  • Phone: 813-846-8426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: