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Contact Information

REVAN LLC
3890 TAMPA RD STE 201
PALM HARBOR, FL34684-3677
 Phone: 727-781-3111
 Fax: 727-781-3113
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Undersea and Hyperbaric Medicine

207PE0005X 93 Physician/Emergency Medicine
Indicates primary specialty

NPI Profile & details for REVAN LLC · (Female)

NPI # 1730145673
Status Active
Credentials
Entity Individual
Enumeration date 04/20/2006
Last updated 07/01/2015 - About 11 years ago
Sole proprietor 1 Not specified
Identifiers
  • FL License # OS4598
  • FL Medicaid 069165800
  • FL Other 82569 BCBS FL
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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