Healthcare Provider Details

I. General information

NPI: 1922685791
Provider Name (Legal Business Name): OLIVIA CHUKWUMA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13321 N 56TH ST
TAMPA FL
33617-1161
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 813-341-1488
  • Fax: 813-341-1489
Mailing address:
  • Phone: 813-341-1488
  • Fax: 813-341-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME175586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: