Healthcare Provider Details

I. General information

NPI: 1649778663
Provider Name (Legal Business Name): FLORIDA ADVANCED ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14003 N DALE MABRY HWY
TAMPA FL
33618-2459
US

IV. Provider business mailing address

14003 N DALE MABRY HWY
TAMPA FL
33618-2459
US

V. Phone/Fax

Practice location:
  • Phone: 813-841-0337
  • Fax:
Mailing address:
  • Phone: 813-841-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberAP3890
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberAP3890
License Number StateFL

VIII. Authorized Official

Name: DR. PATRICK CAPRI
Title or Position: PRESIDENT
Credential: DOM
Phone: 813-961-9174