Healthcare Provider Details

I. General information

NPI: 1063174977
Provider Name (Legal Business Name): GROWINGHAIRCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9535 LAZY LN APT 201
TAMPA FL
33614-1614
US

IV. Provider business mailing address

9535 LAZY LN APT 201
TAMPA FL
33614-1614
US

V. Phone/Fax

Practice location:
  • Phone: 386-868-8091
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SATERRIA SAFFOLD
Title or Position: PROSTHESIS SPECIALIST
Credential:
Phone: 386-868-8091