Healthcare Provider Details

I. General information

NPI: 1679909204
Provider Name (Legal Business Name): NATHANIEL JAMES VINJE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2013
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 HIGHWAY 41 N
INVERNESS FL
34453-2454
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 305
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 352-480-0560
  • Fax: 352-480-0565
Mailing address:
  • Phone: 352-277-5348
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS13053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: