La Tasha Al-Jarboua, PA-C

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

54234 Issued in CA

Practice address

9800 4TH St N Ste 200
St Petersburg, FL 33702-2462

Phone

(833) 399-0957

Fax

(727) 335-1174

NPI assigned

Jun 12, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Enrolled in NC, CA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gateway Community Health Centers, Inc.Group PAC ID 9234356015, shared by 5 NPIs, 6 clinicians

Albemarle Hospital AuthorityGroup PAC ID 9537073770, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Santa Barbara County County Auditor

  • Community/Behavioral Health Agency
  • Santa Barbara, CA
  • NPI 1487857405
  Medicare reassignment NPD
• Blossoming Wellbeing Corp.

  • Psychiatry Physician
  • St Petersburg, FL
  • NPI 1972165231

  Addiction Psychiatry

  NPD Authorized official
• Blossoming Wellbeing Telepsychiatry

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • St Petersburg, FL
  • NPI 1992319560
  NPD Authorized official
• Gateway Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Elizabeth City, NC
  • NPI 1487936514
  Medicare reassignment
• Gates County Medical Center LLC

  • Primary Care Clinic/Center
  • Gatesville, NC
  • NPI 1639217631
  NPD
• Gateway Community Health Centers, Inc

  • Clinic Pharmacy
  • Gatesville, NC
  • NPI 1447843370
  NPD
• Santa Barbara County Auditor

  • Federally Qualified Health Center (FQHC)
  • Lompoc, CA
  • NPI 1649096249
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1588078000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9800 4TH ST N STE 200",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337022462",
            "telephone_number": "833-399-0957",
            "fax_number": "727-335-1174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9800 4TH ST N STE 200",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337022462",
            "telephone_number": "833-399-0957",
            "fax_number": "727-335-1174"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 Main St",
            "address_purpose": "LOCATION",
            "city": "Gatesville",
            "state": "NC",
            "postal_code": "279389424",
            "country_code": "US",
            "telephone_number": "252-357-1226",
            "fax_number": "252-357-1236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AL-JARBOUA",
        "first_name": "LA TASHA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-12",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NC",
            "license": "0010-04854",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NC",
            "license": "0010-04854",
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "CA",
            "license": "54234",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-04854",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54234",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "54234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nina Al Asad
• Obada Al Chouiki, MD
• Maha Rashid Al Ghafry, M.D.
• Yara Al Mazouni, MD
• Hazem F Al-Andary, M.D.
• Tiba Al-Jumaili
• Tara Al-Qutbi
• Aladdin Rehab Center of St Pete LLC
• Swata Alagar, MD
• Alaing Behavioral Health, PLLC

• Child & Adolescent Psychiatry Physician in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.