Organization
FLORIDA CANCER PHYSICIANS NETWORK LLC
Active
Other names
Tampa Bay Cancer Center
Organization subpart
No
Provider details
NPI number
Authorized official
NICK HERNANDEZ MBA FACHE (VP INDIANA & S FLORIDA OPERATIONS)
(813) 662-6024
Entity
Organization
Contact information
Practice address
720 CORTARO DR, RUSKIN, FL 33573-6811
(813) 633-5513
(813) 633-4013
Mailing address
2715 W VIRGINIA AVE, TAMPA, FL 33607-6327
(813) 662-6024
(813) 514-1257
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014A
BCBS
FL
05
—
002715009
—
FL
01
—
DR0495
RR MEDICARE
FL
Enumeration date
07/26/2010
Last updated
09/21/2012
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