Provider Demographics
NPI:1972781672
Name:SERNEELS, ADRIENNE M (MD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:M
Last Name:SERNEELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14451 UNIVERSITY COVE PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3741
Mailing Address - Country:US
Mailing Address - Phone:813-977-4001
Mailing Address - Fax:813-971-3688
Practice Address - Street 1:14451 UNIVERSITY COVE PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3741
Practice Address - Country:US
Practice Address - Phone:813-977-4001
Practice Address - Fax:813-971-3688
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126763207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
R185743Medicare PIN