Individual
DR. NATHAN GRANT HAVERSTICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
17 DAVIS BLVD STE 308, TAMPA, FL 33606-3438
(813) 974-2201
(813) 974-9476
Mailing address
17 DAVIS BLVD STE 308, TAMPA, FL 33606-3438
(813) 974-2201
(813) 974-9476
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
13703
GA
207RI0200X
Infectious Disease Physician
Primary
UO10377
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13703
GEORGIA COMPOSITE MEDICAL BOARD
GA
01
—
UO10377
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
03/22/2021
Last updated
06/18/2025
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