Provider Demographics
NPI:1144856691
Name:CHINESE ACUPUNCTURE AND HERBAL MEDICINE OF TAMPA LLC
Entity type:Organization
Organization Name:CHINESE ACUPUNCTURE AND HERBAL MEDICINE OF TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JULIE
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:AP, DOM
Authorized Official - Phone:817-901-1686
Mailing Address - Street 1:16100 MISTY LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-1315
Mailing Address - Country:US
Mailing Address - Phone:817-901-1686
Mailing Address - Fax:
Practice Address - Street 1:16100 MISTY LN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-1315
Practice Address - Country:US
Practice Address - Phone:817-901-1686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service