Healthcare Provider Details

I. General information

NPI: 1669697181
Provider Name (Legal Business Name): TRENT SAVAGE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 HENDERSON BLVD
TAMPA FL
33609-3024
US

IV. Provider business mailing address

2835 W DE LEON ST STE 202
TAMPA FL
33609-4130
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-2685
  • Fax: 813-876-5872
Mailing address:
  • Phone: 813-877-2685
  • Fax: 813-876-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: