MEDICARE: NORTH TAMPA PHYSICIAN ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RG0100X	Gastroenterology Physician
2	2084P0800X	Psychiatry Physician
3	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1528608155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TAMPA PHYSICIAN ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	18130 LONGWATER RUN DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2211
Country	:	US
Telephone Number	:	352-871-0992
Fax Number	:

Provider Business Practice Location Address
First Line	:	5196 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1802
Country	:	US
Telephone Number	:	352-871-0992
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / PHYSICIAN
Name	:	DR. IHAB HERRAKA
Credential	:	MD
Telephone Number	:	352-871-0992

Provider Enumeration Date	:	01/11/2020
Last Update Date	:	01/11/2020

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