Provider Demographics
NPI:1760819171
Name:FOSS, TRAVIS J (CSFA)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:J
Last Name:FOSS
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38634 TRAVIS LN
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-3081
Mailing Address - Country:US
Mailing Address - Phone:352-424-4043
Mailing Address - Fax:
Practice Address - Street 1:38634 TRAVIS LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-3081
Practice Address - Country:US
Practice Address - Phone:352-424-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL100791246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant