Provider Demographics
NPI:1992001770
Name:XANTHOPOULOS, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:XANTHOPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 PEGGY DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-4133
Mailing Address - Country:US
Mailing Address - Phone:727-510-4941
Mailing Address - Fax:
Practice Address - Street 1:2042 PEGGY DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-4133
Practice Address - Country:US
Practice Address - Phone:727-510-4941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24875175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath