Basic Information
| Provider Information | |||||||||
| NPI: | 1225792724 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAMPA BREASTFEEDING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 CRYSTAL GROVE BLVD | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335486449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138928990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 CRYSTAL GROVE BLVD | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335486449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138928990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2021 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
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| AuthorizedOfficialLastName: | HAMMANT | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8138928990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | IBCLC | ||||||||
| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Lactation Consultant, Non-RN |
No ID Information.