=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699768812
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEX ANTHONY TAMBRINI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2005
-----------------------------------------------------
Last Update Date | 12/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8365 S SUNCOAST BLVD
-----------------------------------------------------
City | HOMOSASSA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34446-5028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-382-0258
-----------------------------------------------------
Fax | 352-382-0416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14690 SPRING HILL DR STE 305
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-8102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-277-5348
-----------------------------------------------------
Fax | 352-606-2857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME98069
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------