Healthcare Provider Details

I. General information

NPI: 1033192661
Provider Name (Legal Business Name): MARGARITA R CANCIO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4729 N HABANA AVE
TAMPA FL
33614-7113
US

IV. Provider business mailing address

4729 N HABANA AVE
TAMPA FL
33614-7113
US

V. Phone/Fax

Practice location:
  • Phone: 813-251-8444
  • Fax:
Mailing address:
  • Phone: 813-251-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: COLBY ENLOW
Title or Position: PRACTICE MANAGER
Credential:
Phone: 813-251-8444