Provider Demographics
NPI:1487660742
Name:UNIVERSITY OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FENNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-974-2388
Mailing Address - Street 1:3612 N ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-5606
Mailing Address - Country:US
Mailing Address - Phone:813-221-5153
Mailing Address - Fax:
Practice Address - Street 1:3612 N ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-5606
Practice Address - Country:US
Practice Address - Phone:813-221-5153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92381261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)