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General NPI Number Information
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NPI Number | 1942562608
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Entity Type | Individual
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Provider Name | DARYL VICTOR NISBETT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3065
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Country | US
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Telephone | 636-807-0008
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-3065
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Country | US
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Telephone | 863-680-7000
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Fax | 866-264-8519
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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 | 182527
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | TP788
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME166414
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License Number State | FL
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