Healthcare Provider Details

I. General information

NPI: 1063003697
Provider Name (Legal Business Name): FLORIDA CANCER SPECIALISTS & RESEARCH INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 OAK MYRTLE LN
WESLEY CHAPEL FL
33544-6328
US

IV. Provider business mailing address

4371 VERONICA S. SHOEMAKER BLVD ATTN: CREDENTIALING
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 727-842-8411
  • Fax: 877-917-2336
Mailing address:
  • Phone: 239-274-8200
  • Fax: 813-499-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: LUCIO NAVARRO GORDAN
Title or Position: PRESIDENT/MANAGING PARTNER
Credential:
Phone: 352-332-3900