Healthcare Provider Details

I. General information

NPI: 1508968488
Provider Name (Legal Business Name): FRANK DAVID FIDLER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 NORTH ROCKY POINT DRIVE WEST SUITE 670
TAMPA FL
33607-5906
US

IV. Provider business mailing address

3030 NORTH ROCKY POINT DRIVE WEST SUITE 670
TAMPA FL
33607-5906
US

V. Phone/Fax

Practice location:
  • Phone: 813-289-6597
  • Fax: 813-289-6592
Mailing address:
  • Phone: 813-289-6597
  • Fax: 813-289-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRN9168596
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9168596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: