Healthcare Provider Details

I. General information

NPI: 1316678030
Provider Name (Legal Business Name): KARINA A TAVIRA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 AVENUE O NE
WINTER HAVEN FL
33881-2409
US

IV. Provider business mailing address

1730 DEBBIE DR
AUBURNDALE FL
33823-9421
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-3103
  • Fax:
Mailing address:
  • Phone: 863-248-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberNA
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: