Healthcare Provider Details

I. General information

NPI: 1568952869
Provider Name (Legal Business Name): BRYAN PATRICK FINK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 54TH AVE S
ST PETERSBURG FL
33712-4610
US

IV. Provider business mailing address

5130 SUNFOREST DR STE 300
TAMPA FL
33634-6327
US

V. Phone/Fax

Practice location:
  • Phone: 727-867-8641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS16903
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberOS16903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: