Healthcare Provider Details

I. General information

NPI: 1376314294
Provider Name (Legal Business Name): AUSTIN EDWARD MAURER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 S LOIS AVE
TAMPA FL
33629-5659
US

IV. Provider business mailing address

813 LUCENT SANDS CT
BRANDON FL
33511-7797
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4200
  • Fax: 813-844-1919
Mailing address:
  • Phone: 239-672-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: