1992014708 NPI number — CARDIOLOGY SPECIALISTS OF FLORIDA PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992014708 NPI number — CARDIOLOGY SPECIALISTS OF FLORIDA PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOLOGY SPECIALISTS OF FLORIDA PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HERNANDO HEART CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992014708
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3069 ANDERSON SNOW RD
Provider Second Line Business Mailing Address:
#219
Provider Business Mailing Address City Name:
SPRING HILL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34609-5202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-597-3353
Provider Business Mailing Address Fax Number:
352-597-3368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14540 CORTEZ BLVD
Provider Second Line Business Practice Location Address:
STE 119
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34613-6056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-597-3353
Provider Business Practice Location Address Fax Number:
352-597-3368
Provider Enumeration Date:
09/28/2010

Additional Information

Authorized Official

Authorized Official Last Name:
FENSTER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-597-3353

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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