Provider Demographics
NPI:1124443130
Name:SOARING CRANE ACUPUNCTURE AND HERBAL MEDICINE, LLC
Entity type:Organization
Organization Name:SOARING CRANE ACUPUNCTURE AND HERBAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENFROE
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:813-770-6225
Mailing Address - Street 1:4003 W SAN RAFAEL ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5733
Mailing Address - Country:US
Mailing Address - Phone:813-770-6225
Mailing Address - Fax:
Practice Address - Street 1:3715 W HORATIO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3917
Practice Address - Country:US
Practice Address - Phone:813-770-6225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty