Healthcare Provider Details

I. General information

NPI: 1528610367
Provider Name (Legal Business Name): COMPREHENSIVE HEMATOLOGY ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 PARK ST N STE 1025
ST PETERSBURG FL
33709-2236
US

IV. Provider business mailing address

5000 PARK ST N STE 1025
ST PETERSBURG FL
33709-2236
US

V. Phone/Fax

Practice location:
  • Phone: 727-344-6569
  • Fax: 727-384-4388
Mailing address:
  • Phone: 727-344-6569
  • Fax: 727-384-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEANINE MARIE MARTIN
Title or Position: CRED
Credential:
Phone: 352-799-0046