1386298172 NPI number — FEMMEMPOWERMENT AND ADVOCACY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386298172 NPI number — FEMMEMPOWERMENT AND ADVOCACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FEMMEMPOWERMENT AND ADVOCACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386298172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11125 PARK BLVD STE 104-129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEMINOLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33772-4757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-704-4540
Provider Business Mailing Address Fax Number:
727-362-1421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 31ST ST S STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33712-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-828-6238
Provider Business Practice Location Address Fax Number:
955-895-0912
Provider Enumeration Date:
07/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SIMMERMAN
Authorized Official First Name:
KAYLEE
Authorized Official Middle Name:
SHEA GARRETT
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
931-704-4540

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1144774563 . This is a "OUT OF NETWORK PROVIDER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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