Provider Demographics
NPI:1245589555
Name:CONCIERGE CARE OF TAMPA BAY, LLC
Entity Type:Organization
Organization Name:CONCIERGE CARE OF TAMPA BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-689-2961
Mailing Address - Street 1:500 VONDERBURG DR STE 214
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5969
Mailing Address - Country:US
Mailing Address - Phone:813-685-2191
Mailing Address - Fax:813-689-8755
Practice Address - Street 1:510 VONDERBURG DR.
Practice Address - Street 2:SUITE 213
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5118
Practice Address - Country:US
Practice Address - Phone:813-685-2191
Practice Address - Fax:813-689-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49552207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty