Healthcare Provider Details

I. General information

NPI: 1497370506
Provider Name (Legal Business Name): NATHAN HENRY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N SEMORAN BLVD STE 206
WINTER PARK FL
32792-3800
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 407-678-2400
  • Fax: 407-678-4926
Mailing address:
  • Phone: 813-444-5838
  • Fax: 833-495-7206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS19912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: