| Organization Name: | CONCIERGE CARE TAMPA BAY LLC |
| NPI Number: | 1568805679 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRIS MICHAEL NUSSBAUM (PRESIDENT) |
| Mailing Address: | 510 Vonderburg Dr Suite 213 Brandon |
| State: | FL US |
| Postal Code: | 335115954 |
| Phone Number: | 8136892961 |
| Fax Number: | 8136852348 |
| NPI Enumeration Date: | 04/09/2013 |
| NPI Last Update Date: | 04/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 49552 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |