Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN15428 | FL |
Y | 213EG0000X | General Practice | DN15428 | FL |
NPI | 1003845991 |
---|---|
Provider Name | Dr. Irma M Tassi |
First Address | Tampa, FL 33606-3155 |
Second Address | St. Petersburg, FL 33744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DN15428 | FL STATE LICENSE # (01) | FL |