Most Relevant Information
Provider Data
| NPI Number: | 1003583642 |
| Provider Name: | NICHOLAS BRENNAN WAGNER MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/23/2021 |
| Last Updated: | 05/03/2022 |
Provider Practice Location
17 DAVIS BLVD STE 308
TAMPA
FL
336063438
Practice Location Phone/Fax
| Phone: | 8139742201 |
| Fax: |
Provider Mailing Location
17 DAVIS BLVD STE 308
TAMPA
FL
336063438
Provider Mailing Phone/Fax
| Phone: | 8139742201 |
| Fax: |