Healthcare Provider Details

I. General information

NPI: 1417957325
Provider Name (Legal Business Name): ATLANTIS CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 TAMPA RD #22
OLDSMAR FL
34677-6300
US

IV. Provider business mailing address

3705 TAMPA RD. SUITE 22
OLDSMAR FL
34677-6346
US

V. Phone/Fax

Practice location:
  • Phone: 813-891-6343
  • Fax: 813-891-6342
Mailing address:
  • Phone: 813-891-6343
  • Fax: 813-891-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. HOWARD NELSON CHIPMAN III
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 813-891-6343