Provider Demographics
NPI:1073546669
Name:NUZZO, DANTE VITO (MD)
Entity Type:Individual
Prefix:DR
First Name:DANTE
Middle Name:VITO
Last Name:NUZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490918
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0918
Mailing Address - Country:US
Mailing Address - Phone:352-323-4800
Mailing Address - Fax:352-323-9103
Practice Address - Street 1:4700 VIA DEL MEDICO
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-9723
Practice Address - Country:US
Practice Address - Phone:352-323-4800
Practice Address - Fax:352-323-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110087595OtherRAILROAD MEDICARE
FL370749100Medicaid
F29117Medicare UPIN