Healthcare Provider Details

I. General information

NPI: 1467857268
Provider Name (Legal Business Name): CHILDRENS HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11464 N 53RD ST
TAMPA FL
33617-2216
US

IV. Provider business mailing address

11464 N 53RD ST
TAMPA FL
33617-2216
US

V. Phone/Fax

Practice location:
  • Phone: 813-914-7772
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH YAKUBU
Title or Position: M.D
Credential:
Phone: 813-914-7772