Healthcare Provider Details

I. General information

NPI: 1992776025
Provider Name (Legal Business Name): FLORENCIO ANTOLIN NADAL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 VICTORIA ST
BRANDON FL
33510-4313
US

IV. Provider business mailing address

PO BOX 2715
BRANDON FL
33509-2715
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-0292
  • Fax: 813-655-4302
Mailing address:
  • Phone: 813-655-0292
  • Fax: 813-655-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME30766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: