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18560 N Dale Mabry Hwy Lutz FL 33548-7900 | |
| (813) 948-7734 | |
| (813) 769-9752 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 18560 N Dale Mabry Hwy, Lutz, Florida |
| Authorized Official Name and Position | Vanessa Acevedo (CLINIC DIRECTOR) |
| Authorized Official Contact | 8139487734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
18560 N Dale Mabry Hwy Lutz FL 33548-7900 Ph: (813) 948-7734 | 18560 N Dale Mabry Hwy Lutz FL 33548-7900 Ph: (813) 948-7734 |
| NPI Number | 1891240503 |
|---|---|
| Provider Enumeration Date | 08/23/2016 |
| Last Update Date | 12/02/2024 |
| Medicare PECOS PAC ID | 1153654819 |
|---|---|
| Medicare Enrollment ID | O20190612000077 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891240503 | NPI | - | NPPES |
| 107332100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LW0102X | Nurse Practitioner - Women's Health | (* (Not Available)) | Secondary |
| Provider Name | Tammara E Masut |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1851734875 PECOS PAC ID: 4880927557 Enrollment ID: I20190612000428 |
| Provider Name | Mariana Giron |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194110304 PECOS PAC ID: 0446589410 Enrollment ID: I20190917002311 |
| Provider Name | Jonathan P Keenan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326451733 PECOS PAC ID: 1355637901 Enrollment ID: I20210506001907 |
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