MEDICARE: KEVIN NUGENT NUGENT

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	2471V0105X	Vascular Sonography Radiologic Technologist	109892	FL

General Provider Information

NPI Number	:	1447559265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN NUGENT NUGENT

Provider Business Mailing Address
First Line	:	PO BOX 271131
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33688-1131
Country	:	US
Telephone Number	:	813-294-0169
Fax Number	:

Provider Business Practice Location Address
First Line	:	12922 N ALBANY AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-3908
Country	:	US
Telephone Number	:	813-294-0169
Fax Number	:

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

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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