Healthcare Provider Details

I. General information

NPI: 1144587841
Provider Name (Legal Business Name): SETH TA'AGAMANUSINA PURCELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10441 QUALITY DR STE 205
SPRING HILL FL
34609-9652
US

IV. Provider business mailing address

10441 QUALITY DR STE 205
SPRING HILL FL
34609-9652
US

V. Phone/Fax

Practice location:
  • Phone: 352-770-8346
  • Fax: 727-755-0926
Mailing address:
  • Phone: 801-472-3563
  • Fax: 727-755-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR3188
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME153952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: