Healthcare Provider Details

I. General information

NPI: 1982660106
Provider Name (Legal Business Name): FITSUM YOHANNES-PETERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 BRUCE B DOWNS BLVD STE 102
WESLEY CHAPEL FL
33544-9207
US

IV. Provider business mailing address

2600 BRUCE B DOWNS BLVD STE 102
WESLEY CHAPEL FL
33544-9207
US

V. Phone/Fax

Practice location:
  • Phone: 813-929-5590
  • Fax: 813-929-5596
Mailing address:
  • Phone: 813-929-5590
  • Fax: 813-929-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberME92187
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME92187
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberME92187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: