Healthcare Provider Details

I. General information

NPI: 1053229674
Provider Name (Legal Business Name): TAMPA CHILDREN'S ENT P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 WEST VIRGINIA AVE
TAMPA FL
33607
US

IV. Provider business mailing address

2814 WEST VIRGINIA AVE
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 813-533-1710
  • Fax: 813-262-1335
Mailing address:
  • Phone: 813-533-1710
  • Fax: 813-262-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE BRENTZ
Title or Position: OWNER-PARTNER
Credential: M.D.
Phone: 813-533-1710