Healthcare Provider Details

I. General information

NPI: 1477053700
Provider Name (Legal Business Name): MRS. ANNETTE KEELY SEYMOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNETTE KEELY MASA

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E OAK AVE
TAMPA FL
33602-2210
US

IV. Provider business mailing address

612 CAPE COD CIR
VALRICO FL
33594-4379
US

V. Phone/Fax

Practice location:
  • Phone: 813-224-9622
  • Fax: 813-224-9622
Mailing address:
  • Phone: 813-298-9290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: