Healthcare Provider Details

I. General information

NPI: 1215413679
Provider Name (Legal Business Name): PSM SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 CORAL RIDGE DR STE 185
CORAL SPRINGS FL
33076-3124
US

IV. Provider business mailing address

5457 NW 122ND DR
CORAL SPRINGS FL
33076-3631
US

V. Phone/Fax

Practice location:
  • Phone: 954-242-2633
  • Fax:
Mailing address:
  • Phone: 954-242-2633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN9332355
License Number StateFL

VIII. Authorized Official

Name: PATRICIA SCHLADWEILER
Title or Position: RNFA
Credential: RNFA
Phone: 954-242-2633