1588384093 NPI number — PAUTLER COHEN FINDLAY EICHENBAUM WHITE AND CRANE MDS PA

Table of content: MRS. CONNIE ROSELLA KOCH AA, CBIS (NPI 1912227299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588384093 NPI number — PAUTLER COHEN FINDLAY EICHENBAUM WHITE AND CRANE MDS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUTLER COHEN FINDLAY EICHENBAUM WHITE AND CRANE MDS PA
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:
6
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:
1588384093
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2705 W SAINT ISABEL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607-6319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-879-5795
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3384 TAMPA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM HARBOR
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34684-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-333-9055
Provider Business Practice Location Address Fax Number:
727-333-9045
Provider Enumeration Date:
09/02/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PAUTLER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
813-879-5795

Provider Taxonomy Codes

  • Taxonomy code: 207WX0107X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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