Healthcare Provider Details

I. General information

NPI: 1699424309
Provider Name (Legal Business Name): ANTHONY NICHOLAS PATERRA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 W KENNEDY BLVD
TAMPA FL
33606-1848
US

IV. Provider business mailing address

1011 E CUMBERLAND AVE UNIT 602
TAMPA FL
33602-4250
US

V. Phone/Fax

Practice location:
  • Phone: 813-893-6300
  • Fax:
Mailing address:
  • Phone: 248-660-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS23059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: