Healthcare Provider Details

I. General information

NPI: 1265069710
Provider Name (Legal Business Name): ANTHONY DOMINIC SORRENTINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RIAD
GAINESVILLE FL
32610-3001
US

IV. Provider business mailing address

PO BOX 103204
GAINESVILLE FL
32610-0001
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0651
  • Fax: 352-265-0153
Mailing address:
  • Phone: 352-265-0651
  • Fax: 352-265-0153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.076413
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME174956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: