Healthcare Provider Details

I. General information

NPI: 1861484966
Provider Name (Legal Business Name): NORBERT NICHOLAS ENGELMAN III D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 FLORIDA AVE
PALM HARBOR FL
34683-4312
US

IV. Provider business mailing address

1745 S HIGHLAND AVE
CLEARWATER FL
33756-1852
US

V. Phone/Fax

Practice location:
  • Phone: 727-259-2300
  • Fax: 727-548-1360
Mailing address:
  • Phone: 727-767-0955
  • Fax: 727-587-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS6151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: