Healthcare Provider Details

I. General information

NPI: 1235948811
Provider Name (Legal Business Name): CLINICAL TRIALS OF TAMPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 W LAMBRIGHT ST
TAMPA FL
33614-4750
US

IV. Provider business mailing address

3430 W LAMBRIGHT ST
TAMPA FL
33614-4750
US

V. Phone/Fax

Practice location:
  • Phone: 813-512-6164
  • Fax: 813-872-7207
Mailing address:
  • Phone: 813-512-6164
  • Fax: 813-872-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name: SONIA DE REGLA MEDINA NUNEZ
Title or Position: SITE ADMINISTRATOR
Credential: RN
Phone: 813-512-6164