Healthcare Provider Details

I. General information

NPI: 1841138476
Provider Name (Legal Business Name): BAKHTOVAR DONIZODA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6147 APPLE SNAIL AVE
NEW PORT RICHEY FL
34653-4711
US

IV. Provider business mailing address

6147 APPLE SNAIL AVE
NEW PORT RICHEY FL
34653-4711
US

V. Phone/Fax

Practice location:
  • Phone: 217-213-8872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11042949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: