Provider Demographics
NPI:1255610366
Name:ANISTA WESTCHASE
Entity type:Organization
Organization Name:ANISTA WESTCHASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JERRI LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERBYSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-695-4843
Mailing Address - Street 1:10718 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1733
Mailing Address - Country:US
Mailing Address - Phone:813-855-4000
Mailing Address - Fax:
Practice Address - Street 1:10718 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1733
Practice Address - Country:US
Practice Address - Phone:813-855-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-07
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care