Provider Demographics
NPI:1689293250
Name:DESOUZA, KARINE (MBBS)
Entity type:Individual
Prefix:
First Name:KARINE
Middle Name:
Last Name:DESOUZA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 RAY CHARLES BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3028
Mailing Address - Country:US
Mailing Address - Phone:727-753-7787
Mailing Address - Fax:883-471-3023
Practice Address - Street 1:1246 RAY CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3028
Practice Address - Country:US
Practice Address - Phone:727-753-7787
Practice Address - Fax:833-471-3023
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160521207Q00000X, 207Q00000X
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program