Provider Demographics
NPI:1104904234
Name:TAMPA BAY FIRST ASSIST
Entity type:Organization
Organization Name:TAMPA BAY FIRST ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:RNFA
Authorized Official - Phone:813-300-5832
Mailing Address - Street 1:7920 CITRUS BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-7477
Mailing Address - Country:US
Mailing Address - Phone:813-300-5832
Mailing Address - Fax:
Practice Address - Street 1:7920 CITRUS BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34637-7477
Practice Address - Country:US
Practice Address - Phone:813-300-5832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2148562251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL312118600Medicaid