Provider Demographics
NPI:1184370751
Name:TAMPA BAY TOTAL WELLNESS
Entity type:Organization
Organization Name:TAMPA BAY TOTAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OBERBROECKLING
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:937-609-1798
Mailing Address - Street 1:300 S. HYDE PARK AVENUE SUITE 210
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606
Mailing Address - Country:US
Mailing Address - Phone:813-609-4150
Mailing Address - Fax:813-441-8122
Practice Address - Street 1:300 S. HYDE PARK AVENUE SUITE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-609-4150
Practice Address - Fax:813-441-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty