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General NPI Number Information
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NPI Number | 1134943657
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Entity Type | Organization
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Legal Business Name | TAMPA FAMILY SPECIALTY SERVICES LLC
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Dates
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Enumeration Date | 11/12/2024
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 2727 W MLK BLVD STE 100A
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City | TAMPA
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State | FL
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Zip | 33607-6353
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Country | US
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Telephone | 813-397-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 2727 W MLK BLVD STE 100A
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City | TAMPA
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State | FL
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Zip | 33607-6353
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Country | US
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Telephone | 813-397-5300
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Fax |
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Authorized Official
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Title or Position | PROJECT DIRECTOR
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Name | CHELSEY L BIBEAU
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Credential |
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Telephone | 720-308-0650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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