Individual
NAZANIN I KHAKPOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12902 MAGNOLIA DRIVE, TAMPA, FL 33612
(888) 860-2778
(813) 745-6511
Mailing address
12902 MAGNOLIA DRIVE, MOD A, TAMPA, FL 33612
(813) 745-3587
(813) 745-4226
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
D63418
GA
208600000X
Surgery Physician
ME100313
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0106
CAREFIRST REGIONAL
MD
01
—
2134681
MDIPA
MD
01
—
252001
KAISER
MD
05
—
408155200
—
MD
01
—
64787501
BLUE SHIELD
MD
01
—
95780
GEISINGER
MD
Enumeration date
07/27/2006
Last updated
06/03/2008
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