NPIMap

Organization Active NPI

Nano Life PL

  • Internal Medicine Physician
  • St Petersburg, FL
National Provider Identifier
1750741534
Registry record updated Apr 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
NANO LIFE PL
Practice address
1201 5TH Ave N Ste 410
St Petersburg, FL 33705-1433
Phone
(727) 580-3719
Fax
(941) 746-4111
NPI assigned
Mar 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Cheryl Smith
Title
Office Manager
Phone
(727) 822-5410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1201 5TH Ave N Ste 410
St Petersburg, FL 33705-1433

Mailing address

1201 5TH Ave N Ste 410
St Petersburg, FL 33705-1433
Phone (727) 580-3719

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160601000517 FL Part B Supplier - Clinic/Group Practice 2062702210 Receives reassigned benefits from 11 practitioners
Practice locations: South Pasadena, FL; St Petersburg, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1523836800000",
    "number": "1750741534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE N STE 410",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051433",
            "telephone_number": "727-580-3719",
            "fax_number": "941-746-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 5TH AVE N STE 410",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337051433",
            "telephone_number": "727-580-3719",
            "fax_number": "941-746-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NANO LIFE PL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-07",
        "last_updated": "2018-04-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "727-822-5410"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.