Individual
ANTONIO CORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12900 CORTEZ BLVD STE 102, BROOKSVILLE, FL 34613-6897
(352) 596-7660
(352) 596-5581
Mailing address
202 ERIC CT, TAMPA, FL 33615
(352) 277-5305
(352) 616-0926
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11000965
FL
363LG0600X
Gerontology Nurse Practitioner
11000965
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11000965
—
FL
01
—
APRN11000965
FL MEDICAL LICENSE
FL
Enumeration date
02/07/2019
Last updated
04/16/2025
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