Healthcare Provider Details

I. General information

NPI: 1932557444
Provider Name (Legal Business Name): ERICA LEA DIBARTOLO-BARCLAY LM, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PALM AVE
TAMPA FL
33602-2717
US

IV. Provider business mailing address

12527 KILLIAN ST
SPRING HILL FL
34609-1451
US

V. Phone/Fax

Practice location:
  • Phone: 813-515-0825
  • Fax: 813-358-3865
Mailing address:
  • Phone: 352-584-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW331
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: