Provider Demographics
NPI:1073189692
Name:TAMPA BAY EYE AND FACIAL AESTHETICS, PLLC
Entity Type:Organization
Organization Name:TAMPA BAY EYE AND FACIAL AESTHETICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREEKMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:276-285-7098
Mailing Address - Street 1:17734 HUNTING BOW CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5383
Mailing Address - Country:US
Mailing Address - Phone:813-550-2020
Mailing Address - Fax:813-682-2525
Practice Address - Street 1:17734 HUNTING BOW CIR STE 102
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5383
Practice Address - Country:US
Practice Address - Phone:813-550-2020
Practice Address - Fax:813-682-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty