Healthcare Provider Details

I. General information

NPI: 1841693611
Provider Name (Legal Business Name): SELVI K KUMAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SELVI KUPPUSWAMY

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR STE 490
TAMPA FL
33613-6600
US

IV. Provider business mailing address

3000 MEDICAL PARK DR STE 490
TAMPA FL
33613-6600
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-2470
  • Fax: 813-971-2491
Mailing address:
  • Phone: 813-971-2470
  • Fax: 813-971-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN46018
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9485700
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN9485700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: