Healthcare Provider Details

I. General information

NPI: 1104156942
Provider Name (Legal Business Name): CRISTA FERRETTI MSOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WESTSHORE BLVD SUITE 601
TAMPA FL
33609-1140
US

IV. Provider business mailing address

600 N WESTSHORE BLVD SUITE 601
TAMPA FL
33609-1140
US

V. Phone/Fax

Practice location:
  • Phone: 813-371-3410
  • Fax: 800-543-0372
Mailing address:
  • Phone: 813-371-3410
  • Fax: 800-543-0372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number11403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: