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General NPI Number Information
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NPI Number | 1205600806
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Entity Type | Organization
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Legal Business Name | FKP TAMPA AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/14/2023
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 514 EICHENFELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5955
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Country | US
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Telephone | 813-358-1568
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Fax | 813-200-1840
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Provider Business Mailing Address
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Address Line | 1 PARKWAY NORTH BLVD STE 200S
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City | DEERFIELD
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State | IL
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Zip | 60015-2534
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Country | US
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Telephone | 847-388-2064
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Fax |
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Authorized Official
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Title or Position | CHIEF OF PROVIDER GROUP OPERATIONS
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Name | LAUREN ELLENBURG
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Credential |
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Telephone | 480-421-8745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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