Healthcare Provider Details

I. General information

NPI: 1528608155
Provider Name (Legal Business Name): NORTH TAMPA PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2020
Last Update Date: 01/11/2020
Certification Date: 01/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5196 MARINER BLVD
SPRING HILL FL
34609-1802
US

IV. Provider business mailing address

18130 LONGWATER RUN DR
TAMPA FL
33647-2211
US

V. Phone/Fax

Practice location:
  • Phone: 352-871-0992
  • Fax:
Mailing address:
  • Phone: 352-871-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IHAB HERRAKA
Title or Position: PRESIDENT / PHYSICIAN
Credential: MD
Phone: 352-871-0992