Healthcare Provider Details

I. General information

NPI: 1881449692
Provider Name (Legal Business Name): RASHIDAT N OKUBOYE MA, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40148 US HIGHWAY 19 N
TARPON SPRINGS FL
34689-8333
US

IV. Provider business mailing address

1850 FULLER DR
CLEARWATER FL
33755-1928
US

V. Phone/Fax

Practice location:
  • Phone: 727-303-8787
  • Fax:
Mailing address:
  • Phone: 727-303-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number640918060014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: