1. Home
  2. Directory
  3. Florida
  4. Tampa
  5. General Practice
  6. NPI Profile

AVITA MEDICAL CLINIC LLC
NPI 1992302574
General Practice in Tampa, FL

Active since October 06, 2020CLIA 10D2187349 · Waiver
14831 N FLORIDA AVE, TAMPA, FL 33613(813) 330-2737(813) 210-9205 Get Directions Write a Review

NPPES record last updated: September 2, 2021. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Aug 25, 2021, Jun 2, 2021, Oct 6, 2020 (3 updates tracked since 2020).

About Avita Medical Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AVITA MEDICAL CLINIC LLC (NPI 1992302574) is a healthcare organization registered as a general practice in Tampa, Florida and active in the NPI registry since October 2020. The organization holds a CLIA Waiver certificate valid through June 29, 2028, maintains a secondary practice location in Tampa, and lists Jenny M Segarra, President, as its authorized official.

NPPES Registry Identity

NPI1992302574
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameAVITA MEDICAL CLINIC LLC
Location Address14831 N FLORIDA AVETampa, FL 33613-1825
Mailing Address14831 N Florida AveTampa, FL 33613-1825 · (813) 210-0982 · Fax (813) 210-9205
Phone(813) 330-2737
Fax(813) 210-9205
Organization SubpartNo
Authorized OfficialJenny M SegarraPresident · (813) 330-2737
Enumeration DateOctober 6, 2020
Last NPPES UpdateSeptember 2, 20213 updates tracked since enumeration
NPPES CertifiedSeptember 2, 2021
✔ NPI 1992302574 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
Also ListedPhysical TherapistTaxonomy 225100000X
Also ListedOccupational TherapistTaxonomy 225X00000X
14831 N FLORIDA AVE, Tampa, FL 33613
Open in Google Maps ↗

Secondary Practice Location 1

Location 114839 N Florida AveTampa, FL 33613-1825 · Phone (813) 330-2737 · Fax (813) 210-9205

Other Identifiers 1

Medicaid109041600FL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2187349

Avita Medical Clinic, LLC · Tampa, FL
Active · expires Jun 29, 2028
CLIA Number10D2187349
Laboratory TypePhysician Office
Certificate Effective DateJune 30, 2026
Certificate Expiration DateJune 29, 2028
Laboratory DirectorJenny M. Segarra
Laboratory Phone(813) 330-2737
Laboratory LocationAvita Medical Clinic, LLC14831 N Florida Ave, Tampa, FL 33613
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

EDDY JIMENEZ CRUZ
Nurse Practitioner (Primary Care)
14831 N FLORIDA AVE
TAMPA, FL 33613
Hillsborough County (813) 330-2737
LUNA HEALTHCARE PARTNERS LLC
Family Medicine
14831 N FLORIDA AVE
TAMPA, FL 33613
Hillsborough County (813) 330-2737

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Avita Medical Clinic LLC's NPI number?

The NPI number for Avita Medical Clinic LLC is 1992302574. It was assigned to this organization in the NPPES registry on October 6, 2020.

Where is Avita Medical Clinic LLC located?

Avita Medical Clinic LLC is located at 14831 N Florida Ave, Tampa, FL 33613. The listed phone number is (813) 330-2737.

What is Avita Medical Clinic LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Does Avita Medical Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2187349) is associated with this NPI, valid through June 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Avita Medical Clinic LLC was last updated on September 2, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.