| St. Joseph's Hospital, Inc. | |
|
4600 N. Habana Avenue Suite 15 Tampa FL 33614-7123 | |
| (813) 870-4460 | |
| (813) 870-4459 |
| Full Name | St. Joseph's Hospital, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 4600 N. Habana Avenue, Tampa, Florida |
| Authorized Official Name and Position | Lynda A Gorken (DIRECTOR) |
| Authorized Official Contact | 7272819390 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Joseph's Hospital, Inc. 4600 N. Habana Avenue Suite 15 Tampa FL 33614-7123 Ph: (813) 870-4460 | St. Joseph's Hospital, Inc. 4600 N. Habana Avenue Suite 15 Tampa FL 33614-7123 Ph: (813) 870-4460 |
| NPI Number | 1992854038 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 03/04/2020 |
| Medicare PECOS PAC ID | 1658274287 |
|---|---|
| Medicare Enrollment ID | O20051229000276 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992854038 | NPI | - | NPPES |
| 379468700 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Deborah L Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912176751 PECOS PAC ID: 0547335622 Enrollment ID: I20080825000493 |
| Provider Name | Pamela S Sabella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841436243 PECOS PAC ID: 2466599873 Enrollment ID: I20091016000158 |
| Provider Name | Scott Ubillos |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1396728911 PECOS PAC ID: 8628262581 Enrollment ID: I20101104000629 |
| Provider Name | Cynthia Mayer |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1720061344 PECOS PAC ID: 2769677434 Enrollment ID: I20101109000192 |
| Provider Name | Peggy L Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285930123 PECOS PAC ID: 1355529504 Enrollment ID: I20110617000280 |
| Provider Name | Pamela R Noel |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1972764710 PECOS PAC ID: 1557532744 Enrollment ID: I20110920000279 |
| Provider Name | Jane N Mai |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1306164264 PECOS PAC ID: 0244467157 Enrollment ID: I20131223000922 |
| Provider Name | Jeniffer Torres-velazco |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1568781953 PECOS PAC ID: 6709103484 Enrollment ID: I20150317001184 |
| Provider Name | Terry Y Law |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063828903 PECOS PAC ID: 0446479612 Enrollment ID: I20160622001698 |
| Provider Name | Kavita M Christensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447757265 PECOS PAC ID: 6103180849 Enrollment ID: I20180507000256 |
| Provider Name | Jean Thibault |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124359021 PECOS PAC ID: 0042406027 Enrollment ID: I20190228002209 |
| Provider Name | Jessica Einwag Arnold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194367136 PECOS PAC ID: 8123454964 Enrollment ID: I20200214000708 |
| Provider Name | Deborah Nicasio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801422969 PECOS PAC ID: 6800215534 Enrollment ID: I20200930001523 |
| Provider Name | Kevin Scott Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083754048 PECOS PAC ID: 7012303704 Enrollment ID: I20220405003002 |
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