Healthcare Provider Details

I. General information

NPI: 1194706051
Provider Name (Legal Business Name): ALPHA BRIDGE CONNECTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 HIGHLAND MANOR DR SUITE 300
TAMPA FL
33610-9712
US

IV. Provider business mailing address

10150 HIGHLAND MANOR DR SUITE 300
TAMPA FL
33610-9712
US

V. Phone/Fax

Practice location:
  • Phone: 813-558-6500
  • Fax: 813-558-6572
Mailing address:
  • Phone: 813-558-6500
  • Fax: 813-558-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARILYN G WOOD
Title or Position: PRESIDENT
Credential:
Phone: 813-558-6561