MR. SEREN DEVOL WALLEN (NPI# 1447336235) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447336235 |
| Entity Type | Individual |
| Full Name | MR. SEREN DEVOL WALLEN |
| Credential | PA-C |
| Practice Address |
4612 N Habana Ave 2nd Fl Tampa FL 33614-7101 |
| Mailing Address |
Po Box 10744 Clearwater FL 33757-8744 |
| Practice Telephone | 8133216580 |
| Practice Fax Number | 8133216581 |
| Mailing Telephone | 7275320002 |
| Mailing Fax Number | 7272664943 |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2017-05-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA-2772 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA9103985 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 292621100 | 05 |
| Street Address |
4612 N HABANA AVE 2ND FL |
| City | TAMPA |
| State | FL |
| Zip Code | 33614-7101 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326008293 | Anthony Joseph Pizzo | Plastic Surgery | 4612 N Habana Ave, Suite 101, Tampa, FL 33614-7112 | 2006-03-24 |
| 1629398714 | Radiology Associates of Tampa Pa | Nuclear Medicine | 4612 N Habana Ave, Florida Cancer Specialists # 200, Tampa, FL 33614-7101 | 2010-06-11 |
| 1326278524 | Cheryl A Murphy | Nurse Practitioner | 4612 N Habana Ave, 2nd Floor, Tampa, FL 33614-7101 | 2009-07-22 |
| 1356578314 | Florida Cancer Specialists P L | Internal Medicine | 4612 N Habana Ave, Suite 200, Tampa, FL 33614-7101 | 2009-06-17 |
| 1932393436 | J. Paonessa M.d.p.a. | Specialist | 4612 N Habana Ave, Tampa, FL 33614-7112 | 2007-08-29 |
| 1235330481 | Zaruhi V. Babayan | Internal Medicine | 4612 N Habana Ave, 2nd Fl, Tampa, FL 33614-7101 | 2007-05-29 |
| 1922161348 | Ellen A. Brankley | Nurse Practitioner | 4612 N Habana Ave, Tampa, FL 33614-7101 | 2006-12-18 |
| 1457453409 | Nicole D Melendez | Internal Medicine | 4612 N Habana Ave, 1st Floor, Tampa, FL 33614-7101 | 2006-09-01 |
| 1568496586 | Hematology Oncology Specialists of Tampa | Specialist | 4612 N Habana Ave, Suite 200, Tampa, FL 33614-7112 | 2006-07-10 |
| 1871529693 | Anthony P Goldman | Internal Medicine | 4612 N Habana Ave, Tampa, FL 33614-7101 | 2006-06-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134733082 | Robin Rollena Stewart | Home Health | 9537 Lazy Lane, Apt 302, Tampa, FL 33614 | 2020-09-08 |
| 1346885761 | David Joseph Page | Nurse Practitioner | St. Joseph's Behavioral Health Center, 4918 N. Habana Ave, Tampa, FL 33614 | 2019-11-08 |
| 1134687411 | Ramon Chang Adult Family Care Home LLC | Custodial Care Facility | 2607 W Humphrey St, Tampa, FL 33614 | 2019-03-06 |
| 1134600612 | Senior Point Assisted Living Facility, LLC | Assisted Living Facility | 2940 W Hillsborough Ave, Tampa, FL 33614 | 2018-08-23 |
| 1306361266 | Larry Valdes | Assisted Living Facility | 4402 W Minnehaha St, Tampa, FL 33614 | 2017-08-11 |
| 1982128062 | Jaime F Casellas Md Corp | Internal Medicine | 4600 N Habana Ave Suit #13, Tampa, FL 33614 | 2017-07-31 |
| 1891219119 | Waveney Gittens-williams | Alzheimer Center (Dementia Center) | 3706 W. Idle Wild Cir #203, Tampa, FL 33614 | 2017-07-28 |
| 1750811857 | Syerita Nicole Morris | Counselor | 6800 N Dale Marby Hwy, Ste 164, Tampa, FL 33614 | 2017-06-13 |
| 1447786124 | Lisa Moy | Case Manager/Care Coordinator | 4001 W. Dr. Martin Luther King Jr. Blvd., Tampa, FL 33614 | 2017-05-02 |
| 1750813804 | Joshua Martin Good | Physical Therapy Assistant | 3363 W. Waters Avenue, Suite 700, Tampa, FL 33614 | 2017-03-29 |
| Find all providers in zip 33614 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508377219 | Hansel David Baez | Physician Assistant | 10740 Palm River Rd Ste 300, Tampa, FL 33619-4577 | 2017-10-20 |
| 1972502714 | Cynthia B Anders | Physician Assistant | 12880 Commodity Pl, Tampa, FL 33626-3101 | 2005-07-14 |
| 1144783630 | Rachel Tipton | Physician Assistant | 909 N Dale Mabry Hwy, Tampa, FL 33609-1251 | 2019-04-11 |
| 1275022618 | Samantha Anna Wloch | Physician Assistant | 12902 Usf Magnolia Dr, Tampa, FL 33612-9416 | 2018-05-01 |
| 1154825537 | Seth Lloyd | Physician Assistant | 10740 Palm River Rd Ste 300, Tampa, FL 33619-4577 | 2018-03-21 |
| 1649782384 | Riley Harms | Physician Assistant | 10740 Palm River Rd Ste 300, Tampa, FL 33619-4577 | 2017-11-03 |
| 1982137824 | Chris Taylor | Physician Assistant | 3000 Medical Park Dr, Ste 500, Tampa, FL 33613-4680 | 2017-04-07 |
| 1184157174 | Maya Niewiadomska | Physician Assistant | 2 Tampa General Cir, Tampa, FL 33606-3603 | 2017-04-06 |
| 1720537921 | Paolo Calizo | Physician Assistant | 3003 W Dr Martin Luther King Jr Blvd Fl 2, Tampa, FL 33607 | 2016-09-28 |
| 1104293380 | Vc-pa First Assist, LLC | Physician Assistant | 10006 Cross Creek Blvd, #449, Tampa, FL 33647-2595 | 2015-08-24 |
| Find all providers in TAMPA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.