=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902326085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARBARA A. DZIUBINSKI LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2017
-----------------------------------------------------
Last Update Date | 06/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9555 SEMINOLE BLVD STE 104
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33772-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-394-1500
-----------------------------------------------------
Fax | 866-632-1343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12050 94TH ST
-----------------------------------------------------
City | LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33773-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-643-3037
-----------------------------------------------------
Fax | 866-632-1343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARBARA ANN DZIUBINSKI
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 727-643-3037
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | ARNP1072652
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------