Healthcare Provider Details

I. General information

NPI: 1083553960
Provider Name (Legal Business Name): FRANCISCO PORTELA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PARK PLACE BLVD STE 180
CLEARWATER FL
33759-4932
US

IV. Provider business mailing address

300 PARK PLACE BLVD STE 180
CLEARWATER FL
33759-4932
US

V. Phone/Fax

Practice location:
  • Phone: 866-750-3373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN55404
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: