Provider Demographics
NPI:1699217190
Name:YOUR BEST YOU, P.A.
Entity Type:Organization
Organization Name:YOUR BEST YOU, P.A.
Other - Org Name:PERSONALIZED PRIMARY & DIABETES SPECIALTY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:VANN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ANP-BC, CDE
Authorized Official - Phone:813-936-2609
Mailing Address - Street 1:15511 N FLORIDA AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1263
Mailing Address - Country:US
Mailing Address - Phone:813-936-2609
Mailing Address - Fax:813-252-4452
Practice Address - Street 1:15511 N FLORIDA AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1263
Practice Address - Country:US
Practice Address - Phone:813-936-2609
Practice Address - Fax:813-252-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL636270OtherMEDICAID ATN INDIV
FLIQ397AOtherMEDICARE PTAN
1245693530OtherNPI FOR YOUR BEST YOU, P.A.
2086 W. BUSCH BLVD.OtherREMOVE THIS ADDRESS
FLIQ399ZOtherMEDICARE PTAN (INDIV.)
FL636246OtherMEDICAID ATN GROUP
2086 W. BUSCH BLVD.OtherREMOVE THIS ADDRESS