Cordova, Antonio Jose

Cordova, Antonio Jose is an sole proprietor health care provider with primary practice located at 12900 Cortez Blvd Ste 102 , Brooksville FL 34613-6897. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Adult Health, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Adult Health is his primary health care specialty. Cordova, Antonio Jose can be contacted via phone (352) 596-7660.

Contact Information

Primary practice address
12900 Cortez Blvd Ste 102 Brooksville FL 34613-6897
Phone: (352) 596-7660
Fax: (352) 596-5581
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X APRN11000965 Florida
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 11000965 Florida

Profile Details

NPI number 1245795996
LBN Legal business name Cordova, Antonio Jose
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 7th, 2019
Last updated Oct 16th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245795996 NPPES
Florida MEDICAID 11000965
Florida Other APRN11000965

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