Provider Demographics
NPI:1497487045
Name:DTSP PRIMARY CARE
Entity Type:Organization
Organization Name:DTSP PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SENIOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:727-210-5623
Mailing Address - Street 1:175 2ND ST S APT 1001
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4319
Mailing Address - Country:US
Mailing Address - Phone:727-210-5823
Mailing Address - Fax:817-612-3416
Practice Address - Street 1:175 2ND ST S APT 1001
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4319
Practice Address - Country:US
Practice Address - Phone:727-210-5823
Practice Address - Fax:817-612-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care