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General NPI Number Information
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NPI Number | 1881647253
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTH CARE OF PINELLAS LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1839 CENTRAL AVE
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City | ST PETERSBURG
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State | FL
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Zip | 33713-8900
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Country | US
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Telephone | 727-322-1054
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Fax | 727-822-8081
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Provider Business Mailing Address
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Address Line | 1839 CENTRAL AVE
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City | ST PETERSBURG
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State | FL
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Zip | 33713-8900
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Country | US
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Telephone | 727-322-1054
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Fax | 727-822-8081
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | CLAUDIA J POULIN
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Credential |
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Telephone | 727-820-1040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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