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General NPI Number Information
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NPI Number | 1902513310
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Entity Type | Individual
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Provider Name | TULSI B DAVE
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Gender | Female
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 11/04/2022
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Provider Practice Location Address
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Address Line | 8136 CENTRALIA CT STE 103
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City | LEESBURG
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State | FL
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Zip | 34788-3757
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Country | US
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Telephone | 352-343-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 3117 RIVER SPRINGS BOULVERD
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City | CLERMONT
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State | FL
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Zip | 34711
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Country | US
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Telephone | 551-208-8824
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1181157
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License Number State | FL
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