Provider Demographics
NPI: | 1952906703 |
---|---|
Name: | HOUSECALLS TAMPA BAY LLC |
Entity Type: | Organization |
Organization Name: | HOUSECALLS TAMPA BAY LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT/OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | TRACY |
Authorized Official - Middle Name: | LYNN |
Authorized Official - Last Name: | GREENE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | ARNP |
Authorized Official - Phone: | 727-831-8376 |
Mailing Address - Street 1: | PO BOX 49106 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAINT PETERSBURG |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33743-9106 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 727-269-5618 |
Mailing Address - Fax: | 727-265-3420 |
Practice Address - Street 1: | 531 MAIN ST STE K |
Practice Address - Street 2: | |
Practice Address - City: | SAFETY HARBOR |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34695-3558 |
Practice Address - Country: | US |
Practice Address - Phone: | 727-831-8376 |
Practice Address - Fax: | 727-265-3420 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-12-01 |
Last Update Date: | 2020-12-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Single Specialty |