Healthcare Provider Details

I. General information

NPI: 1821215120
Provider Name (Legal Business Name): FLORIDA FERTILITY INSTITUTE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2454 N MCMULLEN BOOTH RD SUITE 601
CLEARWATER FL
33759-1353
US

IV. Provider business mailing address

2454 N MCMULLEN BOOTH RD SUITE 601
CLEARWATER FL
33759-1353
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-7705
  • Fax: 727-796-8764
Mailing address:
  • Phone: 727-796-7705
  • Fax: 727-796-8764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NANCY STEIN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 727-669-3403