Avita Medical Clinic LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

AVITA MEDICAL CLINIC LLC

Practice address

14831 N Florida Ave
Tampa, FL 33613-1825

Phone

(813) 330-2737

Fax

(813) 210-9205

NPI assigned

Oct 6, 2020

Organization subpart

No

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

Authorized official

Name

Jenny M Segarra

Title

President

Phone

(813) 330-2737

Specialties & licenses 3

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eddy Jimenez Cruz

  • Primary Care Nurse Practitioner
  • Tampa, FL
  • NPI 1093309510
  NPD
• Yulier Fleitas Dominguez, PMHNP-BC, FNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Tampa, FL
  • NPI 1558837609

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630540800000",
    "number": "1992302574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14831 N FLORIDA AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336131825",
            "telephone_number": "813-210-0982",
            "fax_number": "813-210-9205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14831 N FLORIDA AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336131825",
            "telephone_number": "813-330-2737",
            "fax_number": "813-210-9205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14839 N Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336131825",
            "country_code": "US",
            "telephone_number": "813-330-2737",
            "fax_number": "813-210-9205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AVITA MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A",
        "authorized_official_last_name": "SEGARRA",
        "authorized_official_first_name": "JENNY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-330-2737"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109041600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bluette Aviles
• Samuel Aviles, CSFA
• Stephano Daniel Aviles
• Anastasia Avina, D.D.S
• Avion Anesthesia, PLLC
• Avocy Health Florida, LLC
• Ana Avram Fletcher, PHARMD
• Trenton Avriett
• Paul Kazuhiko Awa, MD
• Amir T Awad, MD, FACG, FACP

• General Practice Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.