Healthcare Provider Details

I. General information

NPI: 1629699889
Provider Name (Legal Business Name): HEART AND VASCULAR ASSOCIATES OF TAMPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 N MACDILL AVE
TAMPA FL
33607-2205
US

IV. Provider business mailing address

2715 N MACDILL AVE
TAMPA FL
33607-2205
US

V. Phone/Fax

Practice location:
  • Phone: 813-280-0202
  • Fax: 813-280-0203
Mailing address:
  • Phone: 813-280-0202
  • Fax: 813-280-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TALAL HAMDAN
Title or Position: OWNER
Credential: MD
Phone: 813-280-0202