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NPI Code Detail

MEDICARE: NIEBLES AND SAMTER MDS P.A

MEDICARE: NIEBLES AND SAMTER MDS P.A
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
1208000000XPediatrics Physician

Other Identifiers

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

General Provider Information

NPI Number : 1568500635
Entity Type Code : Organization
Provider Name (Legal Business Name) : NIEBLES AND SAMTER MDS P.A
Provider Business Mailing Address
First Line : 10549 NORTH FLORIDA AVENUE
Second Line : SUITE B
City : TAMPA
State : FL
Zip : 33612
Country : US
Telephone Number : 813-971-3844
Fax Number : 813-971-3300
Provider Business Practice Location Address
First Line : 10549 NORTH FLORIDA AVENUE
Second Line : SUITE B
City : TAMPA
State : FL
Zip : 33612
Country : US
Telephone Number : 813-971-3844
Fax Number : 813-971-3300
Authorized Official
Title or Position : PRESIDENT
Name : DR. JACQUELINE MARIA NIEBLES
Credential : M.D
Telephone Number : 813-971-3844
Provider Enumeration Date : 02/02/2007
Last Update Date : 08/22/2020

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