Healthcare Provider Details

I. General information

NPI: 1992726228
Provider Name (Legal Business Name): NORTHWEST FLORIDA HEMATOLOGY ONCOLOGY P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 WEST 26TH STREET
LYNN HAVEN FL
32444
US

IV. Provider business mailing address

301 WEST 26TH STREET
LYNN HAVEN FL
32444
US

V. Phone/Fax

Practice location:
  • Phone: 850-914-0700
  • Fax: 850-914-0777
Mailing address:
  • Phone: 850-914-0700
  • Fax: 850-914-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License NumberME86297
License Number StateFL

VIII. Authorized Official

Name: DR. JOHN J NANFRO
Title or Position: PRESIDENT
Credential: M.D., F.A.C.P.
Phone: 850-914-0700