Healthcare Provider Details

I. General information

NPI: 1003447830
Provider Name (Legal Business Name): SALTZMAN, TANIS, PITTELL, LEVIN AND JACOBSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 E EDGEWOOD DR
LAKELAND FL
33803-3604
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 863-669-1212
  • Fax: 863-666-6089
Mailing address:
  • Phone: 954-965-7331
  • Fax: 954-965-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA CORSIATTO
Title or Position: DIRECTOR
Credential:
Phone: 954-965-7331