Healthcare Provider Details

I. General information

NPI: 1447413604
Provider Name (Legal Business Name): NOEL TOLEDO LUNA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD
BAY PINES FL
33744
US

IV. Provider business mailing address

9219 54TH CT E ANCIENT OAKS SUBD
PARRISH FL
34219-5434
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 941-387-5356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number96266
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: