Provider Demographics
NPI:1548485220
Name:ANNE HERMANN MD PA
Entity type:Organization
Organization Name:ANNE HERMANN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:HERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-902-9559
Mailing Address - Street 1:508 S HABANA AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4181
Mailing Address - Country:US
Mailing Address - Phone:813-902-9559
Mailing Address - Fax:813-315-6611
Practice Address - Street 1:508 S HABANA AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4181
Practice Address - Country:US
Practice Address - Phone:813-902-9559
Practice Address - Fax:813-315-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI02035Medicare UPIN
FLU2129YMedicare ID - Type Unspecified
FLK9639Medicare ID - Type Unspecified