Healthcare Provider Details

I. General information

NPI: 1942685433
Provider Name (Legal Business Name): MARY UNANGST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 BRENTWOOD DR
TAMPA FL
33618-2008
US

IV. Provider business mailing address

14410 BRENTWOOD DR
TAMPA FL
33618-2008
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-8183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: