| Locicero Hospital Group Llc | |
|
2605 W Swann Ave Suite 600 Tampa FL 33609-4039 | |
| (813) 876-7073 | |
| (813) 877-1277 |
| Full Name | Locicero Hospital Group Llc |
|---|---|
| Speciality | Hospitalist |
| Location | 2605 W Swann Ave, Tampa, Florida |
| Authorized Official Name and Position | Karon Locicero (OWNER) |
| Authorized Official Contact | 8138767073 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Locicero Hospital Group Llc 2605 W Swann Ave Suite 600 Tampa FL 33609-4039 Ph: (813) 876-7073 | Locicero Hospital Group Llc 2605 W Swann Ave Suite 600 Tampa FL 33609-4039 Ph: (813) 876-7073 |
| NPI Number | 1407392780 |
|---|---|
| Provider Enumeration Date | 01/11/2017 |
| Last Update Date | 01/11/2017 |
| Medicare PECOS PAC ID | 7214204528 |
|---|---|
| Medicare Enrollment ID | O20170517000060 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407392780 | NPI | - | NPPES |
| Provider Name | Elsa U Hale |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497704043 PECOS PAC ID: 0244274348 Enrollment ID: I20050618000059 |
| Provider Name | Karon R Locicero |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255307641 PECOS PAC ID: 3476573155 Enrollment ID: I20090318000494 |
| Provider Name | Melissa A. Howes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548691223 PECOS PAC ID: 0840411286 Enrollment ID: I20141028001185 |
| Provider Name | Elizabeth S Chung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013041714 PECOS PAC ID: 3971725474 Enrollment ID: I20141118001917 |
| Provider Name | Jordan Ryan Lastra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598481574 PECOS PAC ID: 4284004227 Enrollment ID: I20230106002818 |
| Provider Name | Safira Barmanwalla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952034472 PECOS PAC ID: 7416394556 Enrollment ID: I20240509003787 |
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