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General NPI Number Information
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NPI Number | 1033837992
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Entity Type | Organization
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Legal Business Name | TIDEWATER FOOT & ANKLE ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 4168 WOODLANDS PKWY STE B
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City | PALM HARBOR
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State | FL
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Zip | 34685-3496
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Country | US
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Telephone | 813-925-9431
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Fax |
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Provider Business Mailing Address
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Address Line | 13019 W LINEBAUGH AVE STE 101
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City | TAMPA
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State | FL
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Zip | 33626-4507
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Country | US
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Telephone | 813-925-9431
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Fax | 813-925-9442
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Authorized Official
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Title or Position | OWNER
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Name | MEGAN BROOK JOHNSON
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Credential |
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Telephone | 813-925-9431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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