Healthcare Provider Details

I. General information

NPI: 1801317367
Provider Name (Legal Business Name): ANTONIO EDOARDO LUBRANO HEINSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 NURSING HOME DR
ARCADIA FL
34266-3839
US

IV. Provider business mailing address

425 NURSING HOME DR
ARCADIA FL
34266-3839
US

V. Phone/Fax

Practice location:
  • Phone: 863-993-2966
  • Fax:
Mailing address:
  • Phone: 941-263-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME152653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: