Provider Demographics
NPI:1265090385
Name:FAMILY NP TELEMEDICINE
Entity type:Organization
Organization Name:FAMILY NP TELEMEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:386-500-6397
Mailing Address - Street 1:6912 CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-6360
Mailing Address - Country:US
Mailing Address - Phone:813-766-7646
Mailing Address - Fax:813-354-3621
Practice Address - Street 1:6912 CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-6360
Practice Address - Country:US
Practice Address - Phone:813-766-7646
Practice Address - Fax:813-354-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty