Healthcare Provider Details

I. General information

NPI: 1346030012
Provider Name (Legal Business Name): TANIA LEVY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 TUSCANNY ST
BRANDON FL
33511-6165
US

IV. Provider business mailing address

609 TUSCANNY ST
BRANDON FL
33511-6165
US

V. Phone/Fax

Practice location:
  • Phone: 813-843-5344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11039172
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11039172
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11039172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: