Provider Demographics
NPI:1538332937
Name:LANG, NICOLE ANNA-MARGIT (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNA-MARGIT
Last Name:LANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 W DR MLK BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6223
Mailing Address - Country:US
Mailing Address - Phone:813-872-7737
Mailing Address - Fax:813-443-8120
Practice Address - Street 1:3440 W DR MLK BLVD
Practice Address - Street 2:STE. 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6214
Practice Address - Country:US
Practice Address - Phone:813-872-7737
Practice Address - Fax:813-443-8120
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine