Healthcare Provider Details

I. General information

NPI: 1336976901
Provider Name (Legal Business Name): PORTER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 MEMORIAL HWY STE K
TAMPA FL
33615-4574
US

IV. Provider business mailing address

6018 ROSEWOOD DR
TAMPA FL
33615-3428
US

V. Phone/Fax

Practice location:
  • Phone: 813-422-9606
  • Fax:
Mailing address:
  • Phone: 347-422-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YAIME ALAYO LINTON
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 347-422-3085