Provider Demographics
NPI:1306895164
Name:PLEASANTS, TOM A (DO)
Entity type:Individual
Prefix:
First Name:TOM
Middle Name:A
Last Name:PLEASANTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10535 CORAL KEY AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3461
Mailing Address - Country:US
Mailing Address - Phone:813-728-6633
Mailing Address - Fax:
Practice Address - Street 1:13610 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4650
Practice Address - Country:US
Practice Address - Phone:813-977-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE69963Medicare UPIN
FL80412MMedicare ID - Type Unspecified