Healthcare Provider Details

I. General information

NPI: 1508923145
Provider Name (Legal Business Name): ARTISTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11932 SHELDON RD
TAMPA FL
33626
US

IV. Provider business mailing address

11932 SHELDON RD
TAMPA FL
33626
US

V. Phone/Fax

Practice location:
  • Phone: 813-884-0160
  • Fax: 813-885-9383
Mailing address:
  • Phone: 813-884-0160
  • Fax: 813-885-9383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME73754
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME73754
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberME73754
License Number StateFL

VIII. Authorized Official

Name: MS. TANYA OGALESCO
Title or Position: OFFICE MANAGER
Credential:
Phone: 813-884-0160