Healthcare Provider Details

I. General information

NPI: 1831002088
Provider Name (Legal Business Name): PHYSICIANS ENT OF TAMPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 CRESCENT PARK DR FL 1
RIVERVIEW FL
33578-3625
US

IV. Provider business mailing address

3905 CRESCENT PARK DR FL 1
RIVERVIEW FL
33578-3625
US

V. Phone/Fax

Practice location:
  • Phone: 917-742-1682
  • Fax:
Mailing address:
  • Phone: 917-742-1682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSEPH DERBYSHIRE
Title or Position: OWNER AND MED DIRECTOR
Credential: DO
Phone: 917-742-1682