Healthcare Provider Details

I. General information

NPI: 1982135232
Provider Name (Legal Business Name): GENES ADVICE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 N HABANA AVE STE 204
TAMPA FL
33614-7148
US

IV. Provider business mailing address

4730 N HABANA AVE STE 204
TAMPA FL
33614-7148
US

V. Phone/Fax

Practice location:
  • Phone: 813-549-2134
  • Fax: 813-569-1759
Mailing address:
  • Phone: 813-549-2134
  • Fax: 813-569-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACIE LAWSON
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 813-549-2134