Provider Demographics
NPI:1538104286
Name:TA, ALYSSA COOKIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:COOKIE
Last Name:TA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 W TIMBERLANE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-0957
Mailing Address - Country:US
Mailing Address - Phone:813-321-6677
Mailing Address - Fax:813-443-8153
Practice Address - Street 1:1601 W. TIMBERLANE DR.
Practice Address - Street 2:SUITE 400
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33566-0957
Practice Address - Country:US
Practice Address - Phone:813-321-6677
Practice Address - Fax:813-754-9142
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0086121207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266257400Medicaid
FLP00927501Medicare PIN
FL47998XMedicare PIN
FLH75441Medicare UPIN