Provider Demographics
NPI:1215017207
Name:CANNELLA, XAVIER FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:XAVIER
Middle Name:FRANCIS
Last Name:CANNELLA
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 1:3000 MEDICAL PARK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4698
Mailing Address - Country:US
Mailing Address - Phone:813-933-9666
Mailing Address - Fax:
Practice Address - Street 1:3000 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4680
Practice Address - Country:US
Practice Address - Phone:813-933-9666
Practice Address - Fax:813-932-9229
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051082208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274778200Medicaid
E91539Medicare UPIN
FL274778200Medicaid