| Nodal Medical Center Llc | |
|
2123 W Dr Martin Luther King Jr Blvd Ste 101 Tampa FL 33607-6545 | |
| (813) 488-4801 | |
| (813) 405-4506 |
| Full Name | Nodal Medical Center Llc |
|---|---|
| Speciality | General Practice |
| Location | 2123 W Dr Martin Luther King Jr Blvd Ste 101, Tampa, Florida |
| Authorized Official Name and Position | Osvanny Nodal (MEDICAL DOCTOR) |
| Authorized Official Contact | 8134884801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nodal Medical Center Llc 2123 W Dr Martin Luther King Jr Blvd Ste 101 Tampa FL 33607-6545 Ph: (813) 488-4801 | Nodal Medical Center Llc 2123 W Dr Martin Luther King Jr Blvd Ste 101 Tampa FL 33607-6545 Ph: (813) 488-4801 |
| NPI Number | 1114457272 |
|---|---|
| Provider Enumeration Date | 06/12/2017 |
| Last Update Date | 06/20/2019 |
| Medicare PECOS PAC ID | 3577838549 |
|---|---|
| Medicare Enrollment ID | O20171002003387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114457272 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ACN693 (Florida) | Primary |
| Provider Name | Osvanny Nodal |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1467859660 PECOS PAC ID: 4486929452 Enrollment ID: I20171002003443 |
| Provider Name | Cecilia De La Caridad Cruz Almaguer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225630353 PECOS PAC ID: 6901218239 Enrollment ID: I20201210001480 |
| Provider Name | Afrodicio R Hernandez Rivela |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235872953 PECOS PAC ID: 4880078856 Enrollment ID: I20220825002045 |
| Provider Name | Juan Antonio Gaytan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073244034 PECOS PAC ID: 7113302787 Enrollment ID: I20220917000588 |
| Provider Name | Beatriz Calero Morales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336816610 PECOS PAC ID: 0840653051 Enrollment ID: I20230920000474 |
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