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3820 Northdale Blvd Suite 312 B Tampa FL 33624-1863 | |
| (813) 968-3417 | |
| (813) 968-5051 |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 3820 Northdale Blvd, Tampa, Florida |
| Authorized Official Name and Position | Mark D Davis (OWNER) |
| Authorized Official Contact | 8139683417 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3820 Northdale Blvd Suite 312 B Tampa FL 33624-1863 Ph: (813) 968-3417 | 3820 Northdale Blvd Suite 312 B Tampa FL 33624-1863 Ph: (813) 968-3417 |
| NPI Number | 1093114381 |
|---|---|
| Provider Enumeration Date | 08/22/2014 |
| Last Update Date | 08/22/2014 |
| Medicare PECOS PAC ID | 8921321183 |
|---|---|
| Medicare Enrollment ID | O20141220000046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093114381 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | SW3987 (Florida) | Primary |
| Provider Name | Mark D. Davis |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568497857 PECOS PAC ID: 0840466082 Enrollment ID: I20120110000317 |
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