Provider Demographics
NPI:1184685869
Name:DEVABOSE, NATHAN C (MD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:C
Last Name:DEVABOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8425 NORTHCLIFFE BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1107
Mailing Address - Country:US
Mailing Address - Phone:239-598-3131
Mailing Address - Fax:239-592-0438
Practice Address - Street 1:8425 NORTHCLIFFE BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1107
Practice Address - Country:US
Practice Address - Phone:352-686-5255
Practice Address - Fax:352-666-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32254OtherBCBS
FL023900000Medicaid
FL32254WOtherMEDICARE