Provider Demographics
NPI:1750494878
Name:TAMPA WOMEN'S WELLNESS CENTER, P.A.
Entity Type:Organization
Organization Name:TAMPA WOMEN'S WELLNESS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTRELLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:MS ,ARNP
Authorized Official - Phone:813-877-6644
Mailing Address - Street 1:PO BOX 2936
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33568-2936
Mailing Address - Country:US
Mailing Address - Phone:813-877-6644
Mailing Address - Fax:813-877-3501
Practice Address - Street 1:4700 N HABANA AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7160
Practice Address - Country:US
Practice Address - Phone:813-877-6644
Practice Address - Fax:813-877-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2566422363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty