Provider Demographics
NPI:1376138651
Name:AKONWAH, BECKY (NP)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:
Last Name:AKONWAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31029 BACLAN DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-8271
Mailing Address - Country:US
Mailing Address - Phone:813-484-0261
Mailing Address - Fax:813-973-1422
Practice Address - Street 1:8316 HANLEY RD STE 13
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2284
Practice Address - Country:US
Practice Address - Phone:813-670-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011250363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty