Healthcare Provider Details
I. General information
NPI: 1477807477
Provider Name (Legal Business Name): HEM ONC ASSOCIATES OF THE TREASURE COAST, PA
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/30/2012
Last Update Date: 02/10/2022
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2081 SE OCEAN BLVD STE 2A
STUART FL
34996-3348
US
IV. Provider business mailing address
1871 SE TIFFANY AVE SUITE 100
PORT ST LUCIE FL
34952-7596
US
V. Phone/Fax
- Phone: 772-223-5982
- Fax: 223-599-5998
- Phone: 772-335-5666
- Fax: 772-335-3781
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RH0003X |
| Taxonomy | Hematology & Oncology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
NICHOLAS
O
IANNOTTI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 772-335-5666