Provider Demographics
NPI:1871609875
Name:NACUA, CLEOFE CADIZ (RPT)
Entity type:Individual
Prefix:MRS
First Name:CLEOFE
Middle Name:CADIZ
Last Name:NACUA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 42ND AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-7373
Mailing Address - Country:US
Mailing Address - Phone:941-755-8007
Mailing Address - Fax:941-755-8007
Practice Address - Street 1:3106 42ND AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7373
Practice Address - Country:US
Practice Address - Phone:941-755-8007
Practice Address - Fax:941-755-8007
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2430AMedicare ID - Type UnspecifiedMEDICARE PROVIDER