Basic Information
Provider Information | |||||||||
NPI: | 1275796609 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CARING FOR WOMEN OF PINELLAS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3055 5TH AVE N | ||||||||
Address2: |   | ||||||||
City: | SAINT PETERSBURG | ||||||||
State: | FL | ||||||||
PostalCode: | 337136705 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7273234888 | ||||||||
FaxNumber: | 7273234520 | ||||||||
Practice Location | |||||||||
Address1: | 3055 5TH AVE N | ||||||||
Address2: |   | ||||||||
City: | SAINT PETERSBURG | ||||||||
State: | FL | ||||||||
PostalCode: | 337136705 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7273234888 | ||||||||
FaxNumber: | 7273234520 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/07/2008 | ||||||||
LastUpdateDate: | 11/11/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KEPTO | ||||||||
AuthorizedOfficialFirstName: | JOYCE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 7273234888 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | ARNP | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 1073578100 | 01 | FL | INDIVIDUAL NPI | OTHER | 1467509505 | 01 | FL | INDIVIDUAL NPI | OTHER |