Healthcare Provider Details

I. General information

NPI: 1437688033
Provider Name (Legal Business Name): PARTNERS NEURODIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4726 N HABANA AVE STE 100
TAMPA FL
33614-7144
US

IV. Provider business mailing address

4730 N HABANA AVE STE 204
TAMPA FL
33614-7148
US

V. Phone/Fax

Practice location:
  • Phone: 813-769-8855
  • Fax: 813-569-1759
Mailing address:
  • Phone: 813-549-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRACIE LAWSON
Title or Position: COO/MANAGER
Credential:
Phone: 813-549-2134