Provider Demographics
NPI:1215925136
Name:CRISTOFORO, NANCY TODD (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:TODD
Last Name:CRISTOFORO
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 1:10250 SE 167TH PLACE RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8682
Mailing Address - Country:US
Mailing Address - Phone:352-307-9925
Mailing Address - Fax:352-307-8442
Practice Address - Street 1:410 FERN DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7008
Practice Address - Country:US
Practice Address - Phone:352-218-8200
Practice Address - Fax:352-435-0690
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74208207RC0000X
NJ25MA06312900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06818700OtherCDS
NJ25MA06312900OtherLICENSE
NJ25MA06312900OtherLICENSE
NJD06818700OtherCDS
NJE69747Medicare UPIN