Organization
FLORIDA CANCER PHYSICIANS NETWORK LLC
Active
Other names
Cyberknife Cancer Center at Brandon Regional Hospital
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
425 S PARSONS AVE, SUITE 102, BRANDON, FL 33511-5289
(813) 571-6464
(813) 571-6465
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
—
002715004
—
FL
01
—
DR0495
RR MEDICARE
FL
Enumeration date
07/26/2010
Last updated
09/24/2012
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