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General NPI Number Information
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NPI Number | 1225979321
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Entity Type | Individual
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Provider Name | TAINA CANCEL CST/CSFA
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Gender | Female
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 17240 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34601-8921
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Country | US
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Telephone | 352-576-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 10246 MORNINGSTAR AVE
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City | BROOKSVILLE
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State | FL
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Zip | 34601-5138
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Country | US
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Telephone | 352-667-4805
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 179087
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License Number State | FL
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