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General NPI Number Information
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NPI Number | 1417544602
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Entity Type | Organization
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Legal Business Name | PRECISION CANCER CONSULTANTS LLC
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Dates
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Enumeration Date | 12/22/2020
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 14502 N DALE MABRY HWY STE 200
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City | TAMPA
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State | FL
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Zip | 33618-2040
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Country | US
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Telephone | 813-575-6880
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Fax | 813-969-0910
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Provider Business Mailing Address
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Address Line | 14502 N DALE MABRY HWY STE 200
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City | TAMPA
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State | FL
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Zip | 33618-2040
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Country | US
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Telephone | 813-575-6880
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Fax | 813-969-0910
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Authorized Official
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Title or Position | MANAGER
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Name | JODY SIMON
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Credential |
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Telephone | 813-969-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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