MEDICARE: TAMPA BAY HOLISTIC WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	133N00000X	Nutritionist
2	133NN1002X	Nutrition Education Nutritionist
3	174H00000X	Health Educator
4	2083S0010X	Sports Medicine (Preventive Medicine) Physician
5	225400000X	Rehabilitation Practitioner
6	225700000X	Massage Therapist
7	226300000X	Kinesiotherapist
8	405300000X	Prevention Professional
9	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1336792894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY HOLISTIC WELLNESS

Provider Business Mailing Address
First Line	:	1607 N MARION ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-2638
Country	:	US
Telephone Number	:	813-513-4248
Fax Number	:	813-513-3903

Provider Business Practice Location Address
First Line	:	1607 N MARION ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-2638
Country	:	US
Telephone Number	:	813-513-4248
Fax Number	:	813-513-3903

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DAWN ANN MOLINA
Credential	:	DOM
Telephone Number	:	813-513-4248

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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