Healthcare Provider Details

I. General information

NPI: 1063346625
Provider Name (Legal Business Name): FNU NASRULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HCA OAK HILL HOSPITAL, 11375 CORTEZ BLVD
BROOKSVILLE FL
34613
US

IV. Provider business mailing address

7114 BARCLAY AVE APT-C
BROOKSVILLE FL
34609
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-6632
  • Fax:
Mailing address:
  • Phone: 352-616-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN46609
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: