Healthcare Provider Details

I. General information

NPI: 1881339083
Provider Name (Legal Business Name): MARTINA E DAWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13119 W LINEBAUGH AVE STE 101
TAMPA FL
33626-4494
US

IV. Provider business mailing address

2213 RAILRAOD VINE DR APT 305
ODESSA FL
33556
US

V. Phone/Fax

Practice location:
  • Phone: 813-945-7420
  • Fax:
Mailing address:
  • Phone: 727-307-6298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: