Healthcare Provider Details

I. General information

NPI: 1760776736
Provider Name (Legal Business Name): DIANA PATRICIA ESPINOSA-DUQUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12871 CITRUS PLAZA DR
TAMPA FL
33625-3010
US

IV. Provider business mailing address

12871 CITRUS PLAZA DR
TAMPA FL
33625-3010
US

V. Phone/Fax

Practice location:
  • Phone: 813-471-4455
  • Fax: 813-343-5022
Mailing address:
  • Phone: 813-471-4455
  • Fax: 813-343-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME131068
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: