Healthcare Provider Details

I. General information

NPI: 1417864174
Provider Name (Legal Business Name): CENTER FOR CARDIAC & VASCULAR INTERVENTION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 MICCOSUKEE COMMONS DR STE 100
TALLAHASSEE FL
32308-5433
US

IV. Provider business mailing address

1801 MICCOSUKEE COMMONS DR STE 100
TALLAHASSEE FL
32308-5433
US

V. Phone/Fax

Practice location:
  • Phone: 850-509-7567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL STANNARD
Title or Position: SR ADMINISTRATOR
Credential: RN
Phone: 850-509-7567