Provider Demographics
NPI:1386526978
Name:REVIVE PRIMARY CARE & MEDSPA TAMPA
Entity type:Organization
Organization Name:REVIVE PRIMARY CARE & MEDSPA TAMPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAHID
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-482-1688
Mailing Address - Street 1:8606 HUNTERS VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3778
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7620 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3144
Practice Address - Country:US
Practice Address - Phone:813-482-1688
Practice Address - Fax:888-355-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty