Healthcare Provider Details

I. General information

NPI: 1710364864
Provider Name (Legal Business Name): INSAF KOUBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 6TH ST S
ST PETERSBURG FL
33701-4815
US

IV. Provider business mailing address

700 6TH ST S
ST PETERSBURG FL
33701-4815
US

V. Phone/Fax

Practice location:
  • Phone: 727-893-6198
  • Fax: 727-893-6978
Mailing address:
  • Phone: 727-893-6198
  • Fax: 727-893-6978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME168162
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number294850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: