Healthcare Provider Details

I. General information

NPI: 1174366256
Provider Name (Legal Business Name): BEVERLY ANN CIRELLA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2439 COUNTRY PLACE BLVD SUITE 101
TRINITY FL
34655-1104
US

IV. Provider business mailing address

2439 COUNTRY PL BLVD STE 101
TAMPA FL
33613
US

V. Phone/Fax

Practice location:
  • Phone: 813-569-9132
  • Fax:
Mailing address:
  • Phone: 813-569-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: