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NPI Code Detail

MEDICARE: JONATHAN MICHAEL NADOLNE LAT, ATC, CPT

MEDICARE: JONATHAN MICHAEL NADOLNE LAT, ATC, CPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer004609NY
22255A2300XAthletic TrainerAL6981FL

General Provider Information

NPI Number : 1174286421
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN MICHAEL NADOLNE LAT, ATC, CPT
Provider Business Mailing Address
First Line : 5650 BOLLETTIERI BLVD
Second Line :
City : BRADENTON
State : FL
Zip : 34210-2211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5650 BOLLETTIERI BLVD
Second Line :
City : BRADENTON
State : FL
Zip : 34210-2211
Country : US
Telephone Number : 941-739-7491
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2021
Last Update Date : 08/31/2024

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