MEDICARE: MRS. TAWANA EVET MAYBELL RDMS,RVT

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	2471S1302X	Sonography Radiologic Technologist	118611	FL
2	2471V0105X	Vascular Sonography Radiologic Technologist	118611	FL

General Provider Information

NPI Number	:	1245695204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAWANA EVET MAYBELL RDMS,RVT

Provider Business Mailing Address
First Line	:	2415 GRANADA CIR E
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33712-3917
Country	:	US
Telephone Number	:	727-201-8692
Fax Number	:	727-201-8692

Provider Business Practice Location Address
First Line	:	4905 34TH ST S # 287
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33711-4511
Country	:	US
Telephone Number	:	727-201-8692
Fax Number	:	727-201-8692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	12/17/2015

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