Provider Demographics
NPI:1750741534
Name:NANO LIFE PL
Entity type:Organization
Organization Name:NANO LIFE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-822-5410
Mailing Address - Street 1:1201 5TH AVE N STE 410
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1433
Mailing Address - Country:US
Mailing Address - Phone:727-580-3719
Mailing Address - Fax:941-746-4111
Practice Address - Street 1:1201 5TH AVE N STE 410
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1433
Practice Address - Country:US
Practice Address - Phone:727-580-3719
Practice Address - Fax:941-746-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty