MEDICARE: YBOR CITY ELITE SALON

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	1744P3200X	Prosthetics Case Management		FL

General Provider Information

NPI Number	:	1609375856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YBOR CITY ELITE SALON

Provider Business Mailing Address
First Line	:	1910 E 7TH AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-3810
Country	:	US
Telephone Number	:	813-503-0882
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 E 7TH AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-3810
Country	:	US
Telephone Number	:	813-503-0882
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DONETTE KERR
Credential	:	HAIR LOSS
Telephone Number	:	813-503-0882

Provider Enumeration Date	:	02/02/2018
Last Update Date	:	07/21/2022

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Directions to “YBOR CITY ELITE SALON ” Practice Location

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