Provider Demographics
NPI:1134943657
Name:TAMPA FAMILY SPECIALTY SERVICES LLC
Entity type:Organization
Organization Name:TAMPA FAMILY SPECIALTY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-308-0650
Mailing Address - Street 1:2727 W MLK BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6353
Mailing Address - Country:US
Mailing Address - Phone:813-397-5300
Mailing Address - Fax:
Practice Address - Street 1:2727 W MLK BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6353
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-12
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty