Healthcare Provider Details

I. General information

NPI: 1841068095
Provider Name (Legal Business Name): SURGERY CENTER OF TBOPLASTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 01/11/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2963 GULF TO BAY BLVD STE 267
CLEARWATER FL
33759-4255
US

IV. Provider business mailing address

1206 WESTLEY ST
SAFETY HARBOR FL
34695-2709
US

V. Phone/Fax

Practice location:
  • Phone: 727-285-8006
  • Fax: 727-216-6560
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KENDRA DEANGELIS
Title or Position: OWNER
Credential: MD
Phone: 727-285-8006