| Organization Name: | ANU R TATAMBHOTLA MD PA |
| NPI Number: | 1114152188 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANU R TATAMBHOTLA (OWNER) |
| Mailing Address: | 4049 S Ohio Ave Homosassa |
| State: | FL US |
| Postal Code: | 344461138 |
| Phone Number: | 3526281000 |
| Fax Number: | 3526281120 |
| NPI Enumeration Date: | 05/20/2009 |
| NPI Last Update Date: | 05/20/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | FLARNP2962952 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |