Healthcare Provider Details

I. General information

NPI: 1194778852
Provider Name (Legal Business Name): NATHAN J HANFLINK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date: 11/13/2017
Reactivation Date: 11/29/2017

III. Provider practice location address

601 JENNINGS AVE
EUSTIS FL
32726-6148
US

IV. Provider business mailing address

601 JENNINGS AVE
EUSTIS FL
32726-6148
US

V. Phone/Fax

Practice location:
  • Phone: 352-357-0668
  • Fax: 352-357-3642
Mailing address:
  • Phone: 352-357-0668
  • Fax: 352-357-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS9725
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS9725
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS9725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: