Provider Demographics
NPI:1366834475
Name:TAMPA BAY HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:TAMPA BAY HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-238-0857
Mailing Address - Street 1:9917 BROMPTON DR
Mailing Address - Street 2:201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-5419
Mailing Address - Country:US
Mailing Address - Phone:727-238-0857
Mailing Address - Fax:
Practice Address - Street 1:2123 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6549
Practice Address - Country:US
Practice Address - Phone:813-421-3941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty