Provider Demographics
NPI:1770191082
Name:ATWOOD, TWALA NEIA
Entity Type:Individual
Prefix:
First Name:TWALA
Middle Name:NEIA
Last Name:ATWOOD
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 1:3111 W NAPOLEON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-5222
Mailing Address - Country:US
Mailing Address - Phone:804-943-7070
Mailing Address - Fax:
Practice Address - Street 1:3111 W NAPOLEON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-5222
Practice Address - Country:US
Practice Address - Phone:804-943-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171242206310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility