Provider Demographics
NPI:1124642830
Name:TIBSHRAENY, PETRA (DOM)
Entity type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
Last Name:TIBSHRAENY
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7262 MOFFATT LN N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-4827
Mailing Address - Country:US
Mailing Address - Phone:727-420-7600
Mailing Address - Fax:
Practice Address - Street 1:7241 BRYAN DAIRY RD STE B
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1538
Practice Address - Country:US
Practice Address - Phone:727-420-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist