Healthcare Provider Details

I. General information

NPI: 1730583923
Provider Name (Legal Business Name): TINA & MARY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2014
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10580 SPRING HILL DR
SPRING HILL FL
34608-5046
US

IV. Provider business mailing address

10580 SPRING HILL DR
SPRING HILL FL
34608-5046
US

V. Phone/Fax

Practice location:
  • Phone: 352-835-7111
  • Fax: 352-835-7110
Mailing address:
  • Phone: 352-835-7111
  • Fax: 352-835-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME105372
License Number StateFL

VIII. Authorized Official

Name: EID GUIRGUIS
Title or Position: PHYSICIAN
Credential: MD
Phone: 352-835-7111