Healthcare Provider Details

I. General information

NPI: 1912079013
Provider Name (Legal Business Name): ANTHONY NEIL TABULOV RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

IV. Provider business mailing address

1586 SAND HOLLOW LN
PALM HARBOR FL
34683-4838
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-2000
  • Fax:
Mailing address:
  • Phone: 727-789-5614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT7843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: