Provider Demographics
NPI:1376720128
Name:MELROSE WOMEN'S CARE
Entity Type:Organization
Organization Name:MELROSE WOMEN'S CARE
Other - Org Name:SOUTH TAMPA GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/GUNECOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FANARJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-569-0740
Mailing Address - Street 1:2919 W. SWANN AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-569-0740
Mailing Address - Fax:813-864-7603
Practice Address - Street 1:2919 W. SWANN AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-569-0740
Practice Address - Fax:813-864-7603
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MELROSE WOMEN'S CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79261207VG0400X
207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty