Healthcare Provider Details

I. General information

NPI: 1942026059
Provider Name (Legal Business Name): MRS. TANESHA AKITA STUBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6114 OLIVEDALE DR
RIVERVIEW FL
33578-3819
US

IV. Provider business mailing address

6114 OLIVEDALE DR
RIVERVIEW FL
33578-3819
US

V. Phone/Fax

Practice location:
  • Phone: 813-526-3315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number2771564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: