Healthcare Provider Details

I. General information

NPI: 1811650989
Provider Name (Legal Business Name): NIGHT OWL PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 LAND O LAKES BLVD BLDG A
LUTZ FL
33549-2998
US

IV. Provider business mailing address

10359 CROSS CREEK BLVD STE CD
TAMPA FL
33647-2772
US

V. Phone/Fax

Practice location:
  • Phone: 813-994-0044
  • Fax: 813-994-0055
Mailing address:
  • Phone: 813-994-0044
  • Fax: 813-994-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHRAF ADS
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: MD
Phone: 734-306-2518