Healthcare Provider Details

I. General information

NPI: 1700397353
Provider Name (Legal Business Name): NATASHA POLLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2017
Last Update Date: 10/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N REO ST
TAMPA FL
33609-1061
US

IV. Provider business mailing address

550 N REO ST
TAMPA FL
33609-1061
US

V. Phone/Fax

Practice location:
  • Phone: 813-374-2070
  • Fax: 813-337-0937
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: