Healthcare Provider Details

I. General information

NPI: 1578959557
Provider Name (Legal Business Name): JAMIA WASHINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16105 N FLORIDA AVE STE E
LUTZ FL
33549-6161
US

IV. Provider business mailing address

1551 W BAY DR STE 103
LARGO FL
33770-2209
US

V. Phone/Fax

Practice location:
  • Phone: 813-644-4572
  • Fax:
Mailing address:
  • Phone: 727-588-5243
  • Fax: 727-588-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME140428
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: