Provider Demographics
NPI:1669425229
Name:TAPPER, ADA C (ARNP)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:C
Last Name:TAPPER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5668 FISHHAWK CROSSINGS BLVD. STE 121
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547
Mailing Address - Country:US
Mailing Address - Phone:813-324-1604
Mailing Address - Fax:863-774-3777
Practice Address - Street 1:5668 FISHHAWK CROSSINGS BLVD. STE 121
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3354
Practice Address - Country:US
Practice Address - Phone:813-324-1604
Practice Address - Fax:863-774-3777
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9197351363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3861YMedicare PIN
FLQ30086Medicare UPIN