Healthcare Provider Details

I. General information

NPI: 1174449110
Provider Name (Legal Business Name): MARIO ANDRES VIGIL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PINELLAS ST
CLEARWATER FL
33756-3804
US

IV. Provider business mailing address

1735 PAMELIA DR
CLEARWATER FL
33755-2147
US

V. Phone/Fax

Practice location:
  • Phone: 727-900-1669
  • Fax:
Mailing address:
  • Phone: 727-900-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9438364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: