Healthcare Provider Details

I. General information

NPI: 1598567778
Provider Name (Legal Business Name): MY BAE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 WISHING WELL WAY
TAMPA FL
33619-5653
US

IV. Provider business mailing address

1517 WISHING WELL WAY
TAMPA FL
33619-5653
US

V. Phone/Fax

Practice location:
  • Phone: 813-317-6402
  • Fax:
Mailing address:
  • Phone: 813-317-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: TAQUARNA EDRICKA SILVA
Title or Position: CEO
Credential:
Phone: 813-317-6402