1992174239 NPI number — KAMILYA NARIMANOVNA DVOYASHKINA PA

Table of content: KAMILYA NARIMANOVNA DVOYASHKINA PA (NPI 1992174239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992174239 NPI number — KAMILYA NARIMANOVNA DVOYASHKINA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DVOYASHKINA
Provider First Name:
KAMILYA
Provider Middle Name:
NARIMANOVNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1992174239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26844 TANIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33544-4616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-779-6303
Provider Business Mailing Address Fax Number:
888-977-1998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26844 TANIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLEY CHAPEL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-779-6303
Provider Business Practice Location Address Fax Number:
888-977-1998
Provider Enumeration Date:
09/16/2015

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: 363A00000X , with the licence number:  PAT9108923 , 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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