Healthcare Provider Details

I. General information

NPI: 1740742766
Provider Name (Legal Business Name): PERSIS CELINA PUELLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PERSIS CELINA PUELLO

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 S HUEY AVE
TARPON SPRINGS FL
34689-4205
US

IV. Provider business mailing address

14100 58TH ST N STE 100
CLEARWATER FL
33760-9900
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8181
  • Fax:
Mailing address:
  • Phone: 727-824-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME155116
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME155116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: