Provider Demographics
NPI:1710937966
Name:AINTABLIAN, NECTAR (MD)
Entity Type:Individual
Prefix:
First Name:NECTAR
Middle Name:
Last Name:AINTABLIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 PROFESSIONAL PARK CIR STE 80
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4536
Mailing Address - Country:US
Mailing Address - Phone:850-402-5454
Mailing Address - Fax:850-402-5451
Practice Address - Street 1:1881 PROFESSIONAL PARK CIR STE 80
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4536
Practice Address - Country:US
Practice Address - Phone:850-402-5454
Practice Address - Fax:850-402-5451
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME724252080P0208X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251500800Medicaid