Healthcare Provider Details

I. General information

NPI: 1457657462
Provider Name (Legal Business Name): BHAVIN PATEL AAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 02/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE ANESTHESIA DEPT
TAMPA FL
33613-4613
US

IV. Provider business mailing address

PO BOX 23605
TAMPA FL
33623-3605
US

V. Phone/Fax

Practice location:
  • Phone: 813-615-7848
  • Fax:
Mailing address:
  • Phone: 888-533-0566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA82
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: