Organization
MANATEE CARDIOLOGY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD EVANS (VP)
(610) 768-3300
Entity
Organization
Contact information
Practice address
316 MANATEE AVE W, BRADENTON, FL 34205-8805
(941) 748-2277
Mailing address
367 S GULPH RD, KING OF PRUSSIA, PA 19406-3121
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003RJ
BCBS
FL
05
—
006518100
—
FL
01
—
DT1951
RR MEDICARE
FL
Enumeration date
06/21/2012
Last updated
01/20/2022
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