Healthcare Provider Details

I. General information

NPI: 1255236402
Provider Name (Legal Business Name): TIA SEWELL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15411 PLANTATION OAKS DR APT 2
TAMPA FL
33647-2166
US

IV. Provider business mailing address

15411 PLANTATION OAKS DR APT 2
TAMPA FL
33647-2166
US

V. Phone/Fax

Practice location:
  • Phone: 786-494-2168
  • Fax:
Mailing address:
  • Phone: 786-494-2168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: