Provider Demographics
NPI:1477053700
Name:SEYMOUR, ANNETTE KEELY
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:KEELY
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:KEELY
Other - Last Name:MASA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:612 CAPE COD CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4379
Mailing Address - Country:US
Mailing Address - Phone:813-298-9290
Mailing Address - Fax:
Practice Address - Street 1:110 E OAK AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-2210
Practice Address - Country:US
Practice Address - Phone:813-224-9622
Practice Address - Fax:813-224-9622
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator