Healthcare Provider Details

I. General information

NPI: 1215857362
Provider Name (Legal Business Name): JOSEPH CIMINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 STATE ROAD 54
TRINITY FL
34655-1808
US

IV. Provider business mailing address

12484 POPLAR AVE
BROOKSVILLE FL
34614-1946
US

V. Phone/Fax

Practice location:
  • Phone: 727-834-4000
  • Fax:
Mailing address:
  • Phone: 352-540-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9389593
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: