Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 19-81336 | FL |
NPI | 1033775424 |
---|---|
Provider Name | Taisia Portal Starostina |
First Address | Tampa, FL 33604 |
Second Address | Tampa, FL 33604-3360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2019 |
Last Update Date | 12/05/2019 |