Healthcare Provider Details

I. General information

NPI: 1336337203
Provider Name (Legal Business Name): FLORIDA ONCOLOGY NETWORK PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 181
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

PO BOX 1031
ORLANDO FL
32802-1031
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2030
  • Fax: 407-303-2040
Mailing address:
  • Phone: 407-872-7786
  • Fax: 407-872-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME56371
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT JAMES SOLLACCIO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-872-7786