Healthcare Provider Details

I. General information

NPI: 1245821925
Provider Name (Legal Business Name): JOHN YASSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11001 SPRING HILL DR
SPRING HILL FL
34608-5052
US

IV. Provider business mailing address

11001 SPRING HILL DR
SPRING HILL FL
34608-5052
US

V. Phone/Fax

Practice location:
  • Phone: 727-808-6821
  • Fax:
Mailing address:
  • Phone: 727-808-6821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT79770
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS61954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: