Healthcare Provider Details

I. General information

NPI: 1689662462
Provider Name (Legal Business Name): JESUS NAVARRO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/26/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 N HABANA AVE SUITE 300
TAMPA FL
33614-7161
US

IV. Provider business mailing address

4710 N HABANA AVE STE 300
TAMPA FL
33614-7151
US

V. Phone/Fax

Practice location:
  • Phone: 813-890-8004
  • Fax: 813-290-9691
Mailing address:
  • Phone: 813-890-8004
  • Fax: 813-290-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0057891
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME57891
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: