| Organization Name: | TAMPA HEALTHY AGING, INC. |
| NPI Number: | 1881002533 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANTHONY GRANELL (OWNER) |
| Mailing Address: | 15417 N Dale Mabry Hwy Tampa |
| State: | FL US |
| Postal Code: | 336181822 |
| Phone Number: | 8139637500 |
| Fax Number: | |
| NPI Enumeration Date: | 07/25/2014 |
| NPI Last Update Date: | 07/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | OS 5939 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |