DR. NILOUFAR TABATABAEI WILSON (NPI# 1518070119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518070119 |
| Entity Type | Individual |
| Full Name | DR. NILOUFAR TABATABAEI WILSON |
| Credential | MD |
| Practice Address |
350 N Clyde Morris Blvd Daytona Beach FL 32114-2795 |
| Practice Telephone | 3862262100 |
| Mailing Telephone | 3862262100 |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-08-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
143954 | FL | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
49062 | MN | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
102530 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 136617000 | 05 | |
| MN | MEDICARE RAILROAD | P00413289 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 303 N Clyde Morris Blvd, Daytona Beach, FL 321142709 | 3864254000 |
| Street Address |
350 N CLYDE MORRIS BLVD |
| City | DAYTONA BEACH |
| State | FL |
| Zip Code | 32114-2795 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063405975 | Mary June Derbenwick | Psychiatry & Neurology | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2005-08-25 |
| 1205451705 | Tiffany Varela Khan | Nurse Practitioner | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2020-06-10 |
| 1245696301 | Andrea Likens | Dietitian, Registered | 350 N Clyde Morris Blvd, Suite 9, Daytona Beach, FL 32114-2733 | 2016-01-05 |
| 1245560291 | Cara J Karner | Dietetic Technician, Registered | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2010-01-13 |
| 1013189877 | Tyler Jay Staley | Physical Medicine & Rehabilitation | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2008-04-01 |
| 1083734784 | Mark A Miller | Pharmacist | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2007-03-29 |
| 1841322005 | Florida Health Care Plans Inc | Pharmacy | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2007-03-12 |
| 1730258088 | Richard Frank Miller | Nurse Practitioner | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2006-11-08 |
| 1154408904 | Joseph Michael Zobian | Ophthalmology | 350 N Clyde Morris Blvd, Daytona Beach, FL 32114-2733 | 2006-11-01 |
| 1851309629 | Stephen E Minor | Internal Medicine | 350 N Clyde Morris Blvd, Suite 1, Daytona Beach, FL 32114-2733 | 2006-08-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376161380 | Evolution Health & Performance LLC | Physician Assistant | 244 S. Palmetto Ave, Daytona Beach, FL 32114 | 2020-07-07 |
| 1407480189 | Kierra Imani Kinsey | Behavior Technician | 1128-a Beville Rd, Daytona Beach, FL 32114 | 2020-03-02 |
| 1043776057 | Outreach Community Care Network Inc | Pharmacy | 240 N. Frederick Avenue, Daytona Beach, FL 32114 | 2019-02-14 |
| 1033681861 | Katherine Proppe | Specialist/Technologist | 1 Aerospace Blvd, Daytona Beach, FL 32114 | 2018-12-18 |
| 1841765047 | Anna L Smith | Nurse Practitioner | 339 Bill France Blvd Ste C, Daytona Beach, FL 32114 | 2018-10-04 |
| 1154806933 | Steve Anthony Lee | Family Medicine | 731 N. Clyde Morris Blvd, Daytona Beach, FL 32114 | 2018-09-27 |
| 1285116491 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1348 W International Speedway Blvd Ste 2, Daytona Beach, FL 32114 | 2018-09-04 |
| 1770085656 | Merina Lee | Occupational Therapist | 1159 Australia Ave., Daytona Beach, FL 32114 | 2018-03-06 |
| 1346752755 | Hand & Upper Extremity Surgery of Daytona Beach, LLC | Non-Pharmacy Dispensing Site | 1241 Ridgewood Ave, Daytona Beach, FL 32114 | 2017-10-26 |
| 1104347053 | Harry Herman Blanke IIi | Family Medicine | 201 N Clyde Morris Blvd, Suite 200, Halifax Health Family Medicine Residency Program, Daytona Beach, FL 32114 | 2017-06-30 |
| Find all providers in zip 32114 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043488661 | Huijian James Wang | Internal Medicine | 305 Memorial Medical Pkwy Ste 300, Daytona Beach, FL 32117-5170 | 2008-02-16 |
| 1225098981 | Kim Arlan Klancke | Internal Medicine | 655 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2006-03-27 |
| 1417921701 | Humayun Jamidar | Internal Medicine | 311 N Clyde Morris Blvd Ste 320, Daytona Beach, FL 32114-2756 | 2006-02-14 |
| 1972591949 | Donald J. Stoner | Internal Medicine | 303 North Clyde Morris Blvd., Halifax Health Medical Center, Daytona Beach, FL 32114-2709 | 2005-10-12 |
| 1164948360 | Heart Rhythm Specialists At Daytona LLC | Internal Medicine | 305 Memorial Medical Pkwy Ste 300, Daytona Beach, FL 32117-5170 | 2017-08-18 |
| 1033635271 | Eric Lup-sing Lo M. D., P.a. | Internal Medicine | 305 Memorial Medical Pkwy, Daytona Beach, FL 32117-5168 | 2017-08-18 |
| 1871901793 | Florentino Alberto Lupercio Lopez | Internal Medicine | 305 Memorial Medical Pkwy Ste 300, Daytona Beach, FL 32117-5170 | 2014-07-23 |
| 1740559855 | Cardiology Physicians Memorial, LLC | Internal Medicine | 305 Memorial Medical Pkwy, Suite 301, Daytona Beach, FL 32117-5168 | 2011-12-19 |
| 1750514154 | Umang Lalit Shah | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2009-09-01 |
| 1487887295 | Vincent Glenn Peterson | Internal Medicine | 695 N Clyde Morris Blvd, Daytona Beach, FL 32114-2321 | 2009-08-26 |
| Find all providers in DAYTONA BEACH | ||||
| City | DAYTONA BEACH |
| Zip Code | 32114 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.