Provider Demographics
NPI:1568500635
Name:NIEBLES AND SAMTER MDS P.A
Entity type:Organization
Organization Name:NIEBLES AND SAMTER MDS P.A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:NIEBLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-971-3844
Mailing Address - Street 1:10549 NORTH FLORIDA AVENUE
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:813-971-3844
Mailing Address - Fax:813-971-3300
Practice Address - Street 1:10549 NORTH FLORIDA AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-971-3844
Practice Address - Fax:813-971-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty