Healthcare Provider Details

I. General information

NPI: 1679035620
Provider Name (Legal Business Name): NATASHA NICOLE LLANES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/16/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BMG NEUROLOGY MORTON PLANT NORTH BAY, MEDICAL ARTS BLDG 6633 FOREST AVE, SUITE 203
NEW PORT RICHEY FL
34653-3438
US

IV. Provider business mailing address

BMG NEUROLOGY MORTON PLANT NORTH BAY, MEDICAL ARTS BLDG 6633 FOREST AVE, SUITE 203
NEW PORT RICHEY FL
34653-3438
US

V. Phone/Fax

Practice location:
  • Phone: 727-815-7200
  • Fax: 727-333-6430
Mailing address:
  • Phone: 727-815-7200
  • Fax: 727-333-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME163546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: