Healthcare Provider Details

I. General information

NPI: 1861095291
Provider Name (Legal Business Name): FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SANGER RD # A2400
ORLANDO FL
32827-7400
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 407-735-5695
  • Fax:
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROXANE CHERYL WILTSHIRE
Title or Position: ASSOCIATE DIRECTOR OF CREDENTIALING
Credential:
Phone: 239-224-3159