Healthcare Provider Details

I. General information

NPI: 1033209754
Provider Name (Legal Business Name): THOMAS SCOTT GENNARA P.A.-C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/27/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 S MOON AVE
BRANDON FL
33511-5711
US

IV. Provider business mailing address

6006 49TH ST N STE 310
ST PETERSBURG FL
33709-2148
US

V. Phone/Fax

Practice location:
  • Phone: 813-571-9988
  • Fax: 813-571-9922
Mailing address:
  • Phone: 727-490-5040
  • Fax: 727-490-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA1808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: