Provider Demographics
NPI:1063981447
Name:BORGSTROM, ERIK TYLER
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:TYLER
Last Name:BORGSTROM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4427 W LEILA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33616-1007
Mailing Address - Country:US
Mailing Address - Phone:727-459-8188
Mailing Address - Fax:
Practice Address - Street 1:4427 W LEILA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33616-1007
Practice Address - Country:US
Practice Address - Phone:727-459-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9438147163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine