Healthcare Provider Details

I. General information

NPI: 1033068341
Provider Name (Legal Business Name): MR. NAZIM ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 AVENUE I SE
WINTER HAVEN FL
33880-3775
US

IV. Provider business mailing address

454 AVENUE I SE
WINTER HAVEN FL
33880-3775
US

V. Phone/Fax

Practice location:
  • Phone: 727-628-6333
  • Fax:
Mailing address:
  • Phone: 727-628-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberDW61ZZ
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: