Individual
NICHOLAS OSWALD IANNOTTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FACP
Contact information
Practice address
1871 SE TIFFANY AVE, SUITE 100, PORT ST LUCIE, FL 34952-7585
(772) 335-5666
(772) 335-4826
Mailing address
1871 SE TIFFANY AVE, SUITE 100, PORT ST LUCIE, FL 34952-7585
(772) 335-5666
(772) 335-4826
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
0054918
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0054918
STATE LICENSE
FL
05
—
064733100
—
FL
01
—
08210
BLUE CROSS BLUE SHIELD
FL
01
—
830003199
RAILROAD MEDICARE
FL
Enumeration date
06/06/2006
Last updated
06/15/2010
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