MEDICARE: BAYSIDE MEDICAL GROUP

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
1	363LF0000X	Family Nurse Practitioner	ARNP3380082	FL

General Provider Information

NPI Number	:	1154879443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYSIDE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	6228 GREENWICH DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1142
Country	:	US
Telephone Number	:	813-679-7670
Fax Number	:	813-977-8009

Provider Business Practice Location Address
First Line	:	6228 GREENWICH DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-1142
Country	:	US
Telephone Number	:	813-679-7670
Fax Number	:	813-977-8009

Authorized Official
Title or Position	:	ARNP RROVIDER
Name	:	MR. MARTIN AKACHUKWU ESUZOR
Credential	:	ARNPN
Telephone Number	:	813-679-7670

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	09/14/2016

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Directions to “BAYSIDE MEDICAL GROUP ” Practice Location

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