Unknown Individual – Nurse Practitioner, NPI 1104836246

Unknown Individual is a healthcare provider. based in Tampa, Florida. specializing in Nurse Practitioner. They hold a License No. ARNP933502 (FL). The NPI Number for Unknown Individual is 1104836246

Main info

Organization
Inactive
29 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104836246
Phone
(813) 870-4460
Address
4600 N HABANA AVE
Deactivation Date
30 October 2024

Doctor Profile

Medical School Name
UNIVERSITY OF SOUTH FLORIDA COLLEGE OF MEDICINE
Secondary Phone
8138704460
Graduation Year
1997 (29 years ago)
PAC ID
7012917131
Group Practice PAC ID
1658274287
Professional Enrollment ID
I20070112000435
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 4600, North Habana Avenue, Tampa, Hillsborough County, Florida, 33614, United States

    SUITE 15

    TAMPA, FL 336147112

    Phone: (813) 870-4460

    Fax: (813) 870-4459

    Type: Mailing

  • 3554, 1st Avenue North, Central Oak Park, Saint Petersburg, Pinellas County, Florida, 33713, United States

    ST PETERSBURG, FL 337138402

    Phone: (873) 866-0930

    Fax: (727) 321-3811

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33614)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1658274287View full group profile

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1104836246 for Unknown Individual, then check state licensing separately.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Nurse Practitioner. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Tampa, Florida may find Unknown Individual in results; validate coverage separately.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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