Healthcare Provider Details

I. General information

NPI: 1861308397
Provider Name (Legal Business Name): NISHA OF SOUTH FLORIDA TAN MOHIUDDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

10205 PALERMO CIR APT 103
TAMPA FL
33619-5081
US

V. Phone/Fax

Practice location:
  • Phone: 181-384-4700
  • Fax:
Mailing address:
  • Phone: 832-967-7664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS69633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: