1699217190 NPI number — YOUR BEST YOU, P.A.

Table of content: (NPI 1699217190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699217190 NPI number — YOUR BEST YOU, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR BEST YOU, P.A.
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:
PERSONALIZED PRIMARY & DIABETES SPECIALTY CARE
Provider Other Organization Name Type Code:
5
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:
1699217190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15511 N FLORIDA AVE
Provider Second Line Business Mailing Address:
SUITE 502
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33613-1263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-936-2609
Provider Business Mailing Address Fax Number:
813-252-4452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15511 N FLORIDA AVE
Provider Second Line Business Practice Location Address:
SUITE 502
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33613-1263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-936-2609
Provider Business Practice Location Address Fax Number:
813-252-4452
Provider Enumeration Date:
11/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
SHANI
Authorized Official Middle Name:
VANN
Authorized Official Title or Position:
OWNER, NURSE PRACTITIONER
Authorized Official Telephone Number:
813-936-2609

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 636270 . This is a "MEDICAID ATN INDIV" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: IQ397A . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1245693530 . This is a "NPI FOR YOUR BEST YOU, P.A." identifier . This identifiers is of the category "OTHER".
  • Identifier: 2086 W. BUSCH BLVD. . This is a "REMOVE THIS ADDRESS" identifier . This identifiers is of the category "OTHER".
  • Identifier: IQ399Z . This is a "MEDICARE PTAN (INDIV.)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 636246 . This is a "MEDICAID ATN GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com