Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OP00001702 | WA |
N | 207Q00000X | Family Doctor | OS13362 | FL |
Y | 207QA0505X | Family Doctor - Adult Medicine | OS13362 | FL |
NPI | 1083652598 |
---|---|
Provider Name | Tammy C D'souza |
First Address | Lakeland, FL 33805-4543 |
Second Address | Winter Haven, FL 33880-3050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 25/04/2018 |