Healthcare Provider Details

I. General information

NPI: 1700292653
Provider Name (Legal Business Name): DAMON ADAHN FERREIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 11/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 STATE ROAD 54
TRINITY FL
34655-1808
US

IV. Provider business mailing address

15660 GREYROCK DR
SPRING HILL FL
34610-3351
US

V. Phone/Fax

Practice location:
  • Phone: 727-834-4000
  • Fax:
Mailing address:
  • Phone: 727-637-6094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9304594
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9304594
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: