Provider Demographics
NPI:1104345560
Name:NEAL, MAKEBA
Entity type:Individual
Prefix:
First Name:MAKEBA
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4512 PORPOISE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-8413
Mailing Address - Country:US
Mailing Address - Phone:813-410-2165
Mailing Address - Fax:813-984-1190
Practice Address - Street 1:4512 PORPOISE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-8413
Practice Address - Country:US
Practice Address - Phone:813-410-2165
Practice Address - Fax:813-984-1190
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle