Healthcare Provider Details

I. General information

NPI: 1114883923
Provider Name (Legal Business Name): MS. JIHANE BAHBAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2025
Last Update Date: 12/25/2025
Certification Date: 12/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8416 TIDAL BREEZE DR
RIVERVIEW FL
33569-4722
US

IV. Provider business mailing address

8416 TIDAL BREEZE DR
RIVERVIEW FL
33569-4722
US

V. Phone/Fax

Practice location:
  • Phone: 813-766-5002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number908139
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9696094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: