Healthcare Provider Details

I. General information

NPI: 1801198023
Provider Name (Legal Business Name): WEST FLORIDA CARDIOLOGY NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 49TH ST N SUITE 200
SAINT PETERSBURG FL
33709-2148
US

IV. Provider business mailing address

6006 49TH ST N SUITE 200
SAINT PETERSBURG FL
33709-2148
US

V. Phone/Fax

Practice location:
  • Phone: 727-490-2100
  • Fax:
Mailing address:
  • Phone: 727-490-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN JOHANNESSAN
Title or Position: VP
Credential:
Phone: 727-490-2100