Healthcare Provider Details

I. General information

NPI: 1861382376
Provider Name (Legal Business Name): EOS REGENERATIVE AESTHETIC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2059 CENTRAL AVE
SAINT PETERSBURG FL
33713-8814
US

IV. Provider business mailing address

2059 CENTRAL AVE
SAINT PETERSBURG FL
33713-8814
US

V. Phone/Fax

Practice location:
  • Phone: 813-789-3464
  • Fax:
Mailing address:
  • Phone: 813-789-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STACY RIBEIRO
Title or Position: PARTNER
Credential:
Phone: 813-510-0096