Provider Demographics
NPI:1104172600
Name:AFFINITY WELLNESS AND AESTHETIC CENTER
Entity type:Organization
Organization Name:AFFINITY WELLNESS AND AESTHETIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-964-5901
Mailing Address - Street 1:PO BOX 262647
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33685-2647
Mailing Address - Country:US
Mailing Address - Phone:813-964-5901
Mailing Address - Fax:
Practice Address - Street 1:6822 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2212
Practice Address - Country:US
Practice Address - Phone:813-964-5901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty