Provider Demographics
NPI:1952807117
Name:PIZZUTTO, TATIANNA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:TATIANNA
Middle Name:MICHELLE
Last Name:PIZZUTTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 BRYAN DAIRY RD STE 250
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1259
Mailing Address - Country:US
Mailing Address - Phone:727-391-6296
Mailing Address - Fax:727-392-8452
Practice Address - Street 1:8787 BRYAN DAIRY RD STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1259
Practice Address - Country:US
Practice Address - Phone:727-391-6296
Practice Address - Fax:727-392-8452
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142208207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104581300Medicaid