Healthcare Provider Details

I. General information

NPI: 1992001770
Provider Name (Legal Business Name): EVA XANTHOPOULOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2042 PEGGY DR
HOLIDAY FL
34690-4133
US

IV. Provider business mailing address

2042 PEGGY DR
HOLIDAY FL
34690-4133
US

V. Phone/Fax

Practice location:
  • Phone: 727-510-4941
  • Fax:
Mailing address:
  • Phone: 727-510-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number24875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: