Provider Demographics
NPI:1649862970
Name:TAMPA BAY DIRECT CARE LLC
Entity type:Organization
Organization Name:TAMPA BAY DIRECT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RONNIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-519-5180
Mailing Address - Street 1:410 S WARE BLVD STE 825
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4469
Mailing Address - Country:US
Mailing Address - Phone:813-519-5180
Mailing Address - Fax:209-290-3512
Practice Address - Street 1:410 S WARE BLVD STE 825
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4469
Practice Address - Country:US
Practice Address - Phone:813-519-5180
Practice Address - Fax:209-290-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care