Healthcare Provider Details

I. General information

NPI: 1194311209
Provider Name (Legal Business Name): ERIKA IANNONE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19048 BRUCE B DOWNS BLVD # B 7/8
TAMPA FL
33647-2434
US

IV. Provider business mailing address

19048 BRUCE B DOWNS BLVD # B 7/8
TAMPA FL
33647-2434
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-1201
  • Fax:
Mailing address:
  • Phone: 813-972-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH26552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: