Healthcare Provider Details

I. General information

NPI: 1811955362
Provider Name (Legal Business Name): STEPHEN PHILIP NIMBARGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/12/2021
Certification Date: 01/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAITLAND AVE STE 1000
ALTAMONTE SPRINGS FL
32701-5449
US

IV. Provider business mailing address

PO BOX 150038
ALTAMONTE SPRINGS FL
32715-0038
US

V. Phone/Fax

Practice location:
  • Phone: 407-331-6236
  • Fax: 407-331-6953
Mailing address:
  • Phone: 407-782-3702
  • Fax: 407-331-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME85807
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME85807
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: