MEDICARE: DR. ALYSSA COOKIE TA M.D.

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	207V00000X	Obstetrics & Gynecology Physician	ME0086121	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1538104286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSSA COOKIE TA M.D.

Provider Business Mailing Address
First Line	:	1601 W TIMBERLANE DR STE 400
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-0957
Country	:	US
Telephone Number	:	813-321-6677
Fax Number	:	813-443-8153

Provider Business Practice Location Address
First Line	:	1601 W. TIMBERLANE DR.
Second Line	:	SUITE 400
City	:	TAMPA
State	:	FL
Zip	:	33566-0957
Country	:	US
Telephone Number	:	813-321-6677
Fax Number	:	813-754-9142

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/22/2022

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