Provider Demographics
NPI:1811650989
Name:NIGHT OWL PEDIATRICS PA
Entity type:Organization
Organization Name:NIGHT OWL PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ADS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-306-2518
Mailing Address - Street 1:10359 CROSS CREEK BLVD STE CD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2772
Mailing Address - Country:US
Mailing Address - Phone:813-994-0044
Mailing Address - Fax:813-994-0055
Practice Address - Street 1:1730 LAND O LAKES BLVD BLDG A
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-2998
Practice Address - Country:US
Practice Address - Phone:813-994-0044
Practice Address - Fax:813-994-0055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIGHT OWL PEDIATRICS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME103546OtherMEDICAL LICENSE