Healthcare Provider Details

I. General information

NPI: 1184251449
Provider Name (Legal Business Name): NICOLE CARDOSO DRAGNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE MARGARET CARDOSO MD

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14055 RIVEREDGE DR STE 250
TAMPA FL
33637-2141
US

IV. Provider business mailing address

14055 RIVEREDGE DR STE 250
TAMPA FL
33637-2141
US

V. Phone/Fax

Practice location:
  • Phone: 813-396-6238
  • Fax:
Mailing address:
  • Phone: 813-396-6238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12509
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME178835
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: