Healthcare Provider Details

I. General information

NPI: 1811498652
Provider Name (Legal Business Name): TAMPA BAY HOSPITALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 CENTRAL AVE
ST PETERSBURG FL
33713-8900
US

IV. Provider business mailing address

1839 CENTRAL AVE
ST PETERSBURG FL
33713-8900
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-1040
  • Fax: 727-821-7213
Mailing address:
  • Phone: 727-820-1040
  • Fax: 727-821-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA J POULIN
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 727-820-1040