Healthcare Provider Details

I. General information

NPI: 1700588068
Provider Name (Legal Business Name): TEJAS NITIN PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10924 BLOOMINGDALE AVE
RIVERVIEW FL
33578-3633
US

IV. Provider business mailing address

10924 BLOOMINGDALE AVE
RIVERVIEW FL
33578-3633
US

V. Phone/Fax

Practice location:
  • Phone: 813-571-1111
  • Fax: 813-571-1120
Mailing address:
  • Phone: 813-571-1111
  • Fax: 813-571-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS23599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: