Provider Demographics
NPI:1801972070
Name:NOMULA, SUVARNA (MD)
Entity type:Individual
Prefix:DR
First Name:SUVARNA
Middle Name:
Last Name:NOMULA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20431 BRUCE B DOWNS BLVD
Mailing Address - Street 2:NEW TAMPA MEDICAL CLINIC
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:813-994-9995
Mailing Address - Fax:813-994-8019
Practice Address - Street 1:20431 BRUCE B DOWNS BLVD
Practice Address - Street 2:NEW TAMPA MEDICAL CLINIC
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647
Practice Address - Country:US
Practice Address - Phone:813-994-9995
Practice Address - Fax:813-994-8019
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME85978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBN7405663OtherDEA
FLH55804Medicare UPIN
FL62684YMedicare PIN