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NPI Code Detail

MEDICARE: DR. TANYA MICHELLE LIBERATO MD

MEDICARE: DR. TANYA MICHELLE LIBERATO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianME0079054FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134146673
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TANYA MICHELLE LIBERATO MD
Provider Business Mailing Address
First Line : 4033 TAMPA RD
Second Line : STE.101
City : OLDSMAR
State : FL
Zip : 34677-3224
Country : US
Telephone Number : 813-854-2003
Fax Number : 813-855-2367
Provider Business Practice Location Address
First Line : 10729 QUEENS TOWN DR
Second Line :
City : RIVERVIEW
State : FL
Zip : 33579-7186
Country : US
Telephone Number : 813-672-3497
Fax Number : 813-741-2418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 06/10/2021

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