MEDICARE: UNIVERSITY OF SOUTH FLORIDA

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	ME92381	FL

General Provider Information

NPI Number	:	1487660742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF SOUTH FLORIDA

Provider Business Mailing Address
First Line	:	3612 N ARLINGTON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-5606
Country	:	US
Telephone Number	:	813-221-5153
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 N ARLINGTON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33603-5606
Country	:	US
Telephone Number	:	813-221-5153
Fax Number	:

Authorized Official
Title or Position	:	FELLOW
Name	:	DR. LEAH ANNE FENNELL
Credential	:	MD
Telephone Number	:	813-974-2388

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/22/2020

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Directions to “UNIVERSITY OF SOUTH FLORIDA ” Practice Location

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