Basic Information
| Provider Information | |||||||||
| NPI: | 1154725778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAIRAMDAS | ||||||||
| FirstName: | KUMAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP,ARNP,FNP-C,ENP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12909 CINNIMON PL | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336244504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133007813 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2020 TOWN CENTER BLVD | ||||||||
| Address2: | STE B | ||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136778418 | ||||||||
| FaxNumber: | 8133771686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2014 | ||||||||
| LastUpdateDate: | 08/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9246190 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 015206800 | 05 | FL | MEDICAID | Y0S6U | 01 | FL | BC/BS FLORIDA BLUE | OTHER | P01667516 | 01 | FL | RR MEDICARE | OTHER |