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General NPI Number Information
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NPI Number | 1750175501
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Entity Type | Organization
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Legal Business Name | ACKERMAN CANCER CENTER, PA
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 520 W TWINCOURT TRL STE 4-5
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-8987
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Country | US
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Telephone | 904-880-5522
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37016
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City | TAMPA
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State | FL
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Zip | 33631-9016
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Country | US
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Telephone | 904-880-5522
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SCOT ACKERMAN
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Credential | MD
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Telephone | 904-880-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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