Healthcare Provider Details

I. General information

NPI: 1477781219
Provider Name (Legal Business Name): NUCCI MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6322 GUNN HIGHWAY
TAMPA FL
33625
US

IV. Provider business mailing address

6322 GUNN HIGHWAY
TAMPA FL
33625
US

V. Phone/Fax

Practice location:
  • Phone: 813-864-3998
  • Fax: 813-864-3971
Mailing address:
  • Phone: 813-864-3998
  • Fax: 813-864-3971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS7010
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME66521
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT C NUCCI
Title or Position: MANAGER
Credential: MD
Phone: 813-864-3998