Healthcare Provider Details

I. General information

NPI: 1003441254
Provider Name (Legal Business Name): ANDJELA NEMCEVIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDJELA NEMCEVIC

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15416 N FLORIDA AVE
TAMPA FL
33613-1210
US

IV. Provider business mailing address

4197 WOODLANDS PKWY
PALM HARBOR FL
34685-3493
US

V. Phone/Fax

Practice location:
  • Phone: 813-960-2400
  • Fax: 813-960-2410
Mailing address:
  • Phone: 813-333-1512
  • Fax: 813-333-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME173384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: