Healthcare Provider Details

I. General information

NPI: 1437484474
Provider Name (Legal Business Name): AMBER SHAKIRA TAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER SHAKIRA JOHNSON D.O.

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5398 PARK ST N
ST PETERSBURG FL
33709-1041
US

IV. Provider business mailing address

5398 PARK ST N
ST PETERSBURG FL
33709-1041
US

V. Phone/Fax

Practice location:
  • Phone: 727-544-1441
  • Fax: 727-545-8263
Mailing address:
  • Phone: 727-544-1441
  • Fax: 727-545-8263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS11158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: