Healthcare Provider Details

I. General information

NPI: 1124448014
Provider Name (Legal Business Name): GINGER LYNN URBANIAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 WALSINGHAM RD STE 200
LARGO FL
33774-3515
US

IV. Provider business mailing address

2111 DREW ST STE 200
CLEARWATER FL
33765-3215
US

V. Phone/Fax

Practice location:
  • Phone: 727-447-4536
  • Fax: 727-442-1600
Mailing address:
  • Phone: 727-447-4536
  • Fax: 727-442-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME126575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: