Provider Demographics
NPI:1568456820
Name:APS GYNECOLOGY, PA
Entity Type:Organization
Organization Name:APS GYNECOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:PAULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-787-7350
Mailing Address - Street 1:4302 N HABANA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6368
Mailing Address - Country:US
Mailing Address - Phone:813-870-3890
Mailing Address - Fax:813-877-8517
Practice Address - Street 1:2901 W SAINT ISABEL ST
Practice Address - Street 2:STE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6371
Practice Address - Country:US
Practice Address - Phone:813-870-3890
Practice Address - Fax:813-877-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043806207V00000X
FLME0070754207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30778ZMedicare ID - Type Unspecified
FL31505ZMedicare ID - Type Unspecified
D54123Medicare UPIN
G28347Medicare UPIN