Healthcare Provider Details

I. General information

NPI: 1841798543
Provider Name (Legal Business Name): DWIC OF TAMPA BAY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CARIBBEAN WAY
MIAMI FL
33132-2028
US

IV. Provider business mailing address

1050 CARIBBEAN WAY
MIAMI FL
33132-2028
US

V. Phone/Fax

Practice location:
  • Phone: 813-282-1225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN LOKANT
Title or Position: SUPERVISOR, CREDENTIALING
Credential:
Phone: 763-330-8813