Provider Demographics
NPI:1609405588
Name:PRATT-EUGENE, AMINA MALIKA
Entity Type:Individual
Prefix:
First Name:AMINA
Middle Name:MALIKA
Last Name:PRATT-EUGENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 E FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1742
Mailing Address - Country:US
Mailing Address - Phone:813-586-7600
Mailing Address - Fax:
Practice Address - Street 1:17512 DONA MICHELLE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3265
Practice Address - Country:US
Practice Address - Phone:813-586-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL20233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program