Healthcare Provider Details

I. General information

NPI: 1497208805
Provider Name (Legal Business Name): 211 TAMPA BAY CARES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14155 58TH STREET NORTH SUITE 211
CLEARWATER FL
33760
US

IV. Provider business mailing address

14155 58TH STREET NORTH SUITE 211
CLEARWATER FL
33760
US

V. Phone/Fax

Practice location:
  • Phone: 727-403-4062
  • Fax:
Mailing address:
  • Phone: 727-403-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MICKI THOMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 727-403-4062