Healthcare Provider Details

I. General information

NPI: 1487967923
Provider Name (Legal Business Name): FLORIDA CANCER PHYSICIANS NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 EMERGENCY LN
SEBRING FL
33870-5534
US

IV. Provider business mailing address

2715 W VIRGINIA AVE
TAMPA FL
33607-6327
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-8811
  • Fax:
Mailing address:
  • Phone: 813-662-6024
  • Fax: 813-514-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: NICK HERNANDEZ
Title or Position: VP INDIANA AND S FLORIDA OPERATIONS
Credential: MBA FACHE
Phone: 813-662-6024