Active NPI
Tina Ittera
- Pharmacist
- Saint Cloud, FL
National Provider Identifier
1679409825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS40997
- Practice address
- 4073 13TH St
Saint Cloud, FL 34769-6701 - Phone
- (407) 969-8130
- NPI assigned
- Jun 23, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS40997 | FL | Primary |
Addresses
Primary practice location
4073 13TH St
Saint Cloud, FL 34769-6701
Mailing address
4507 Seafarer Way
Orlando, FL 32817-3181
Phone (407) 969-8130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ebenezer Clinical Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Ebenezer Clinical Pharmacy
- Community/Retail Pharmacy
- Saint Cloud, FL
- NPI 1285161083
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1782172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782172800000",
"number": "1679409825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4507 SEAFARER WAY",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328173181",
"telephone_number": "407-969-8130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4073 13TH ST",
"city": "SAINT CLOUD",
"state": "FL",
"postal_code": "347696701",
"telephone_number": "407-969-8130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ITTERA",
"first_name": "TINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-06-23",
"last_updated": "2026-06-23",
"certification_date": "2026-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS40997",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.