Provider Demographics
NPI:1275821191
Name:TIPIRNENI, KAVITHA (DO)
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:TIPIRNENI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAVITHA
Other - Middle Name:
Other - Last Name:WAGGONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:500 TRINITY LN N
Mailing Address - Street 2:APT 8201
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1215
Mailing Address - Country:US
Mailing Address - Phone:727-623-4459
Mailing Address - Fax:
Practice Address - Street 1:500 TRINITY LN N
Practice Address - Street 2:APT 8201
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1215
Practice Address - Country:US
Practice Address - Phone:727-623-4459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11211207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology