Provider Demographics
NPI:1003902347
Name:ADVANCED ENTS OF TAMPA BAY LLC
Entity Type:Organization
Organization Name:ADVANCED ENTS OF TAMPA BAY LLC
Other - Org Name:TRINA E ESPINOLA MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:ESPINOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-553-7100
Mailing Address - Street 1:625 6TH AVE S
Mailing Address - Street 2:SUITE 385
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4662
Mailing Address - Country:US
Mailing Address - Phone:727-553-7100
Mailing Address - Fax:
Practice Address - Street 1:625 6TH AVE S
Practice Address - Street 2:SUITE 385
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4662
Practice Address - Country:US
Practice Address - Phone:727-553-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINA E ESPINOLA MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064176207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268350400Medicaid