Healthcare Provider Details

I. General information

NPI: 1518592823
Provider Name (Legal Business Name): FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 CARE DR STE 101
TALLAHASSEE FL
32308-4489
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 850-219-5830
  • Fax: 850-671-1251
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LUCIO NAVARRO GORDAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 239-274-8200