Healthcare Provider Details

I. General information

NPI: 1194157032
Provider Name (Legal Business Name): SPECTRA HEALTHCARE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N REO ST
TAMPA FL
33609-1013
US

IV. Provider business mailing address

504 N REO ST
TAMPA FL
33609-1013
US

V. Phone/Fax

Practice location:
  • Phone: 813-353-0911
  • Fax: 813-353-0914
Mailing address:
  • Phone: 813-353-0911
  • Fax: 813-353-0914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME74302
License Number StateFL

VIII. Authorized Official

Name: LISA SAFF KOCHE
Title or Position: OWNER
Credential: M.D.
Phone: 813-353-0911