Healthcare Provider Details

I. General information

NPI: 1083794788
Provider Name (Legal Business Name): MICHAEL D'ANNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 THONOTOSASSA RD
PLANT CITY FL
33563-1464
US

IV. Provider business mailing address

231 W JEAN ST
TAMPA FL
33604-6643
US

V. Phone/Fax

Practice location:
  • Phone: 813-754-5678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO4859
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: