Provider Demographics
NPI:1497963979
Name:NISHIHORI, TAIGA (MD)
Entity Type:Individual
Prefix:DR
First Name:TAIGA
Middle Name:
Last Name:NISHIHORI
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 1:12902 USF MAGNOLIA DR
Mailing Address - Street 2:MAILSTOP: FOB3
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9416
Mailing Address - Country:US
Mailing Address - Phone:813-745-8156
Mailing Address - Fax:813-745-4284
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:MAILSTOP: FOB3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-8156
Practice Address - Fax:813-745-4284
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044133207R00000X, 207RH0000X, 207RX0202X
FLME106972207R00000X, 207RH0003X, 207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002067300Medicaid
FL002067300Medicaid