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NPI Code Detail

MEDICARE: TABITHA GENNARA APRN

MEDICARE: TABITHA GENNARA APRN
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
1363LF0000XFamily Nurse PractitionerAPRN9249781FL
2363LP0808XPsychiatric/Mental Health Nurse PractitionerARPN9249781FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2FS953ZOTHERFLMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3Y09PWOTHERFLBCBS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285915801
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABITHA GENNARA APRN
Provider Business Mailing Address
First Line : 14502 N DALE MABRY HWY STE 200
Second Line :
City : TAMPA
State : FL
Zip : 33618-2040
Country : US
Telephone Number : 813-592-4275
Fax Number :
Provider Business Practice Location Address
First Line : 14502 N DALE MABRY HWY STE 200
Second Line :
City : TAMPA
State : FL
Zip : 33618-2040
Country : US
Telephone Number : 813-699-9410
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2011
Last Update Date : 08/21/2024

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Directions to “ TABITHA GENNARA APRN” Practice Location

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