Provider Demographics
NPI:1972045235
Name:JOSE, SIJI (ARNP)
Entity type:Individual
Prefix:
First Name:SIJI
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 N ASHLEY DR
Mailing Address - Street 2:STE 1625
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4300
Mailing Address - Country:US
Mailing Address - Phone:813-289-6597
Mailing Address - Fax:800-908-6613
Practice Address - Street 1:400 N ASHLEY DR
Practice Address - Street 2:STE 1625
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4300
Practice Address - Country:US
Practice Address - Phone:813-289-6597
Practice Address - Fax:800-908-6613
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP 9252887363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner