Basic Information
| Provider Information | |||||||||
| NPI: | 1710961313 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NABILA NIAZ MD PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NEPHROLOGY PA | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 5TH AVENUE NORTH | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337051457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278212388 | ||||||||
| FaxNumber: | 7278216887 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 5TH AVENUE NORTH | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337051457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278212388 | ||||||||
| FaxNumber: | 7278216887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NIAZ | ||||||||
| AuthorizedOfficialFirstName: | NABILA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7278212388 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 46394 | 01 | FL | BLUE SHIELD | OTHER | DD2999 | 01 | RAILROAD RETIREMENT | OTHER |