Provider Demographics
NPI:1942038286
Name:BRAVANT LLC
Entity type:Organization
Organization Name:BRAVANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:TORGBOR
Authorized Official - Last Name:SAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-600-9981
Mailing Address - Street 1:3218 W HORATIO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3028
Mailing Address - Country:US
Mailing Address - Phone:813-600-9981
Mailing Address - Fax:
Practice Address - Street 1:8250 BRYAN DAIRY RD STE 305
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1360
Practice Address - Country:US
Practice Address - Phone:727-391-5008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care