Healthcare Provider Details

I. General information

NPI: 1417294158
Provider Name (Legal Business Name): FLORIDA NERVE MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8198 S JOG RD #100
BOYNTON BEACH FL
33472-2900
US

IV. Provider business mailing address

741 DUCHESS CT
PALM BEACH GARDENS FL
33410-1553
US

V. Phone/Fax

Practice location:
  • Phone: 561-602-6191
  • Fax: 561-429-3630
Mailing address:
  • Phone: 561-602-6191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME96190
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberME96190
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License NumberME96190
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME96190
License Number StateFL

VIII. Authorized Official

Name: HILDEGARDE GEISSE
Title or Position: OWNER
Credential: M.D.
Phone: 561-310-7759