Healthcare Provider Details

I. General information

NPI: 1629403720
Provider Name (Legal Business Name): DISCOVERY AT HOME GULF COAST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2013
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W BUSCH BLVD STE 407
TAMPA FL
33618-4566
US

IV. Provider business mailing address

2901 W BUSCH BLVD STE 407
TAMPA FL
33618-4566
US

V. Phone/Fax

Practice location:
  • Phone: 813-634-3343
  • Fax: 813-634-3323
Mailing address:
  • Phone: 813-634-3433
  • Fax: 813-634-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PETERSEN
Title or Position: DIRECTOR OF QUALITY ASSURANCE
Credential: RN
Phone: 801-707-1797