1578538864 NPI number — MR. NORMAN BLAINE STREETER M.S., A.R.N.P

Table of content: MRS. ELIZABETH MARIE CARNAVAL LCAT, ATR-BC (NPI 1346316775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578538864 NPI number — MR. NORMAN BLAINE STREETER M.S., A.R.N.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STREETER
Provider First Name:
NORMAN
Provider Middle Name:
BLAINE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S., A.R.N.P
Provider Gender Code:
M

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:
1578538864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1319 FOXBORO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33511-6255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-786-5884
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13000 BRUCE B DOWNS BLVD
Provider Second Line Business Practice Location Address:
CARDIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612-4745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-972-2000
Provider Business Practice Location Address Fax Number:
813-978-5893
Provider Enumeration Date:
02/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP3414342 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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