Healthcare Provider Details

I. General information

NPI: 1689445611
Provider Name (Legal Business Name): CARSON HSING CHAVEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N WEST SHORE BLVD STE 240
TAMPA FL
33607-4629
US

IV. Provider business mailing address

8105 COLONIAL VILLAGE DR APT 106
TAMPA FL
33625-6804
US

V. Phone/Fax

Practice location:
  • Phone: 813-636-8300
  • Fax:
Mailing address:
  • Phone: 321-795-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9122061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: