MEDICARE: MRS. MARA FAITH KEYS PA-C

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	363A00000X	Physician Assistant	PA3540	FL

General Provider Information

NPI Number	:	1275597833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARA FAITH KEYS PA-C

Provider Business Mailing Address
First Line	:	9317 HERITAGE OAK CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2536
Country	:	US
Telephone Number	:	813-991-7988
Fax Number	:	866-299-3968

Provider Business Practice Location Address
First Line	:	1300 BRUCE B DOWNS BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-9217
Country	:	US
Telephone Number	:	813-972-2000
Fax Number	:	813-903-4874

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	01/08/2009

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