Healthcare Provider Details

I. General information

NPI: 1093696452
Provider Name (Legal Business Name): ANAY TEJEDA COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5056 TEATHER ST
SPRING HILL FL
34608-2944
US

IV. Provider business mailing address

3204 RIVER GROVE DR
TAMPA FL
33610-1561
US

V. Phone/Fax

Practice location:
  • Phone: 813-379-1419
  • Fax:
Mailing address:
  • Phone: 813-379-1419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: