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General NPI Number Information
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NPI Number | 1073189692
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Entity Type | Organization
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Legal Business Name | TAMPA BAY EYE AND FACIAL AESTHETICS, PLLC
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Dates
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Enumeration Date | 06/03/2021
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Last Update Date | 06/03/2021
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Provider Practice Location Address
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Address Line | 17734 HUNTING BOW CIR STE 102
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City | LUTZ
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State | FL
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Zip | 33558-5383
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Country | US
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Telephone | 813-550-2020
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Fax | 813-682-2525
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Provider Business Mailing Address
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Address Line | 17734 HUNTING BOW CIR STE 102
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City | LUTZ
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State | FL
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Zip | 33558-5383
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Country | US
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Telephone | 813-550-2020
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Fax | 813-682-2525
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Authorized Official
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Title or Position | PRESIDENT
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Name | SARA CREEKMORE
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Credential | DO
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Telephone | 276-285-7098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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