Healthcare Provider Details

I. General information

NPI: 1518660307
Provider Name (Legal Business Name): EMILY AMMON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD STE 308
TAMPA FL
33606-3438
US

IV. Provider business mailing address

17 DAVIS BLVD STE 308
TAMPA FL
33606-3438
US

V. Phone/Fax

Practice location:
  • Phone: 181-382-1870
  • Fax:
Mailing address:
  • Phone: 181-382-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME181538
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: