Provider Demographics
NPI:1730698226
Name:USORO, UNYIME
Entity type:Individual
Prefix:
First Name:UNYIME
Middle Name:
Last Name:USORO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 COCONUT PALM DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8362
Mailing Address - Country:US
Mailing Address - Phone:813-489-4569
Mailing Address - Fax:865-769-3454
Practice Address - Street 1:3901 COCONUT PALM DR
Practice Address - Street 2:SUITE 120
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619
Practice Address - Country:US
Practice Address - Phone:813-489-4569
Practice Address - Fax:865-769-3454
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9350169363LF0000X
FLAPRN9350169363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730698226Medicaid
FL1730698226OtherMEDICARE