Healthcare Provider Details

I. General information

NPI: 1316841992
Provider Name (Legal Business Name): DEFY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 N ARMENIA AVE STE 220
TAMPA FL
33603-1436
US

IV. Provider business mailing address

4809 N ARMENIA AVE STE 220
TAMPA FL
33603-1436
US

V. Phone/Fax

Practice location:
  • Phone: 813-445-7342
  • Fax:
Mailing address:
  • Phone: 813-445-7342
  • Fax: 813-445-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE BRUCE
Title or Position: VICE PRESIDENT
Credential: VP
Phone: 813-445-7342