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General NPI Number Information
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NPI Number | 1497487045
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Entity Type | Organization
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Legal Business Name | DTSP PRIMARY CARE
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 175 2ND ST S APT 1001
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4319
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Country | US
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Telephone | 727-210-5823
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Fax | 817-612-3416
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Provider Business Mailing Address
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Address Line | 175 2ND ST S APT 1001
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4319
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Country | US
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Telephone | 727-210-5823
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Fax | 817-612-3416
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | DR. JENNIFER MARY SENIOR
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Credential | DNP
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Telephone | 727-210-5623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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