Healthcare Provider Details

I. General information

NPI: 1518942473
Provider Name (Legal Business Name): THOMAS ALAN NAKAGAWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S DEPT #6580070302
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

501 6TH AVE S DEPT #6580070302
ST PETERSBURG FL
33701-4634
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4429
  • Fax: 727-767-8526
Mailing address:
  • Phone: 727-767-4429
  • Fax: 727-767-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME127112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: