MEDICARE: MRS. JIPSA CHIRAG PATEL M.S.

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	101YM0800X	Mental Health Counselor	IMH 11891	FL

General Provider Information

NPI Number	:	1265854822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JIPSA CHIRAG PATEL M.S.

Provider Business Mailing Address
First Line	:	1817 TARA MARIE LN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-6080
Country	:	US
Telephone Number	:	386-386-2294
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 W WATERS AVE
Second Line	:	SUITE 406
City	:	TAMPA
State	:	FL
Zip	:	33634-1229
Country	:	US
Telephone Number	:	813-881-1000
Fax Number	:

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

Provider Enumeration Date	:	01/15/2014
Last Update Date	:	01/15/2014

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