=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851351985
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMPA BAY AREA CANCER CONSULTANTS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2006
-----------------------------------------------------
Last Update Date | 04/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4114 WOODLANDS PKWY SUITE 301
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34685-3494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-789-2595
-----------------------------------------------------
Fax | 727-450-1058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 850001
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32885-0306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-789-2595
-----------------------------------------------------
Fax | 727-789-8891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | D ANDA NORBERGS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-789-2595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | ME0056118
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------