MEDICARE: DR. MARK DOUGLAS NANNI MD

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
1	2085R0202X	Diagnostic Radiology Physician	ME45556	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184620692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK DOUGLAS NANNI MD

Provider Business Mailing Address
First Line	:	122 LINSLEY AVE
Second Line	:	STE A
City	:	BRANDON
State	:	FL
Zip	:	33511-5121
Country	:	US
Telephone Number	:	813-657-4914
Fax Number	:	813-657-4916

Provider Business Practice Location Address
First Line	:	613 OAKFIELD DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5714
Country	:	US
Telephone Number	:	813-661-2222
Fax Number	:	813-681-8494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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