Healthcare Provider Details

I. General information

NPI: 1710963236
Provider Name (Legal Business Name): BAYFRONT ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 11/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 4TH ST N
ST PETERSBURG FL
33702-5910
US

IV. Provider business mailing address

7601 SEMINOLE BLVD
SEMINOLE FL
33772-4859
US

V. Phone/Fax

Practice location:
  • Phone: 727-526-3627
  • Fax:
Mailing address:
  • Phone: 727-394-8442
  • Fax: 727-392-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NATHAN KEITH WALDREP
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 727-893-6707