Healthcare Provider Details

I. General information

NPI: 1467664367
Provider Name (Legal Business Name): ADRIANA ISABEL KIERECKI BA - ITDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W. DR. MARTIN LUTHER KING BLVD.
TAMPA FL
33614
US

IV. Provider business mailing address

4001 W. DR. MARTIN LUTHER KING BLVD.
TAMPA FL
33614
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-1605
  • Fax: 813-876-1620
Mailing address:
  • Phone: 813-876-1605
  • Fax: 813-876-1620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: