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General NPI Number Information
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NPI Number | 1972500841
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Entity Type | Organization
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Legal Business Name | CENTER FOR RADIATION ONCOLOGY OF TAMPA BAY IN
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 7315 GREEN SLOPE DR
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City | ZEPHYRHILLS
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State | FL
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Zip | 33541-1314
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Country | US
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Telephone | 813-783-8614
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Fax | 813-783-8538
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Provider Business Mailing Address
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Address Line | 2715 WEST VIRGINIA AVENUE
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City | TAMPA
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State | FL
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Zip | 33607-6327
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Country | US
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Telephone | 813-662-6024
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Fax | 813-514-1257
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Authorized Official
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Title or Position | VP INDIANA AND SOUTH FLORIDA OPERAI
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Name | MR. NICK L HERNANDEZ
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Credential | MBA, FACHE
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Telephone | 813-662-6024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 59-3204668
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License Number State | FL
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