Healthcare Provider Details

I. General information

NPI: 1396845400
Provider Name (Legal Business Name): DIAGNOSTIC PATHOLOGY OF FLORIDA SUNCOAST, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10461 QUALITY DR
SPRING HILL FL
34609-9634
US

IV. Provider business mailing address

5901 SW 74TH ST SUITE 202
MIAMI FL
33143-5165
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-4614
  • Fax: 305-667-0239
Mailing address:
  • Phone: 305-665-4614
  • Fax: 305-667-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEDWINA COLINA
Title or Position: MD
Credential: M.D.
Phone: 352-688-8200