Healthcare Provider Details

I. General information

NPI: 1962074682
Provider Name (Legal Business Name): AUSTIN T PRINCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 26TH AVE E
BRADENTON FL
34208-7753
US

IV. Provider business mailing address

PO BOX 197515
NASHVILLE TN
37219-7515
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4600
  • Fax: 941-782-4601
Mailing address:
  • Phone: 941-782-4600
  • Fax: 941-782-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME160739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: