Healthcare Provider Details

I. General information

NPI: 1932469566
Provider Name (Legal Business Name): C & D PULMONARY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7614 JACQUE RD STE C
HUDSON FL
34667-7195
US

IV. Provider business mailing address

7614 JACQUE RD STE C
HUDSON FL
34667-7195
US

V. Phone/Fax

Practice location:
  • Phone: 727-857-5967
  • Fax:
Mailing address:
  • Phone: 727-857-5967
  • Fax: 727-857-5972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREA TRENT
Title or Position: REGISTERED AGENT
Credential:
Phone: 727-857-5967