Healthcare Provider Details

I. General information

NPI: 1154725778
Provider Name (Legal Business Name): KUMAR JAIRAMDAS DNP,ARNP,FNP-C,ENP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 TOWN CENTER BLVD STE B
BRANDON FL
33511
US

IV. Provider business mailing address

12909 CINNIMON PL
TAMPA FL
33624-4504
US

V. Phone/Fax

Practice location:
  • Phone: 813-677-8418
  • Fax: 813-377-1686
Mailing address:
  • Phone: 813-300-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9246190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: