Provider Demographics
NPI:1942842042
Name:INFORMEDDNA MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:INFORMEDDNA MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-975-4819
Mailing Address - Street 1:111 2ND AVE. NE SUITE 700
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3441
Mailing Address - Country:US
Mailing Address - Phone:800-975-4819
Mailing Address - Fax:760-203-1194
Practice Address - Street 1:111 2ND AVE. NE SUITE 700
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3441
Practice Address - Country:US
Practice Address - Phone:800-975-4819
Practice Address - Fax:760-203-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty