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General NPI Number Information
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NPI Number | 1245795996
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Entity Type | Individual
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Provider Name | ANTONIO CORDOVA
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Gender | Male
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Dates
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Enumeration Date | 02/07/2019
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 12900 CORTEZ BLVD STE 102
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City | BROOKSVILLE
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State | FL
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Zip | 34613-6897
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Country | US
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Telephone | 352-596-7660
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Fax | 352-596-5581
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Provider Business Mailing Address
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Address Line | 202 ERIC CT
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City | TAMPA
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State | FL
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Zip | 33615
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Country | US
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Telephone | 352-277-5305
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Fax | 352-616-0926
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 11000965
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11000965
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License Number State | FL
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