Provider Demographics
NPI:1811984685
Name:DELTA HEALTHCARE OF TAMPA
Entity type:Organization
Organization Name:DELTA HEALTHCARE OF TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PPS COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:813-971-2383
Mailing Address - Street 1:1818 E FLETCHER AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3770
Mailing Address - Country:US
Mailing Address - Phone:813-971-2383
Mailing Address - Fax:813-971-7708
Practice Address - Street 1:1818 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-3770
Practice Address - Country:US
Practice Address - Phone:813-971-2383
Practice Address - Fax:813-971-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105140Medicare ID - Type Unspecified