Provider Demographics
NPI:1871294439
Name:KENEA, GIFTI BOGALE
Entity type:Individual
Prefix:
First Name:GIFTI
Middle Name:BOGALE
Last Name:KENEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4714 N HABANA AVE APT 1804
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7133
Mailing Address - Country:US
Mailing Address - Phone:813-817-8279
Mailing Address - Fax:
Practice Address - Street 1:4714 N HABANA AVE APT 1804
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7133
Practice Address - Country:US
Practice Address - Phone:813-817-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN55949246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist