Provider Demographics
NPI:1174781710
Name:TAWWAB, JUVERIA (MD)
Entity type:Individual
Prefix:
First Name:JUVERIA
Middle Name:
Last Name:TAWWAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 952824
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-2824
Mailing Address - Country:US
Mailing Address - Phone:407-302-1331
Mailing Address - Fax:
Practice Address - Street 1:2605 W LAKE MARY BLVD
Practice Address - Street 2:#119
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3568
Practice Address - Country:US
Practice Address - Phone:407-878-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119485207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017249900Medicaid
FLIB827ZMedicare PIN
FL017249900Medicaid
KY00503041Medicare PIN
KYK011100Medicare PIN