Healthcare Provider Details

I. General information

NPI: 1023286085
Provider Name (Legal Business Name): ERIC MICHAEL NORMAN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LAKELAND HILLS BLVD
LAKELAND FL
33805-4543
US

IV. Provider business mailing address

2214 VILLAGE PARK RD APT 204
PLANT CITY FL
33563-2058
US

V. Phone/Fax

Practice location:
  • Phone: 863-687-1100
  • Fax:
Mailing address:
  • Phone: 813-464-9903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT 8560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: