Provider Demographics
NPI:1265189997
Name:PATEL, KAREENA VIPUL
Entity type:Individual
Prefix:
First Name:KAREENA
Middle Name:VIPUL
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E TWIGGS ST UNIT 902
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3175
Mailing Address - Country:US
Mailing Address - Phone:843-455-7122
Mailing Address - Fax:
Practice Address - Street 1:4710 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7161
Practice Address - Country:US
Practice Address - Phone:813-879-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-04-26
Deactivation Date:2022-03-05
Deactivation Code:
Reactivation Date:2022-04-26
Provider Licenses
StateLicense IDTaxonomies
PA9115731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant