Healthcare Provider Details

I. General information

NPI: 1881559581
Provider Name (Legal Business Name): DEREK EARLE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2917 25TH ST W
BRADENTON FL
34205-3657
US

IV. Provider business mailing address

2917 25TH ST W
BRADENTON FL
34205-3657
US

V. Phone/Fax

Practice location:
  • Phone: 727-400-8049
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DEREK EARLE
Title or Position: OWNER
Credential:
Phone: 727-400-8049