Healthcare Provider Details

I. General information

NPI: 1538229976
Provider Name (Legal Business Name): MARY JANE DOBSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 ZEMKE AVE
TAMPA FL
33621-5023
US

IV. Provider business mailing address

3250 ZEMKE AVE
TAMPA FL
33621-5023
US

V. Phone/Fax

Practice location:
  • Phone: 813-827-9336
  • Fax: 813-827-9488
Mailing address:
  • Phone: 813-827-9336
  • Fax: 813-827-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number644931
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP2546502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: