Healthcare Provider Details

I. General information

NPI: 1477266724
Provider Name (Legal Business Name): FLORIDA VEINS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4961 ROYAL GULF CIR
FORT MYERS FL
33966-7006
US

IV. Provider business mailing address

1641 E OSBORN RD STE 4
PHOENIX AZ
85016-7146
US

V. Phone/Fax

Practice location:
  • Phone: 480-630-2886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JARED REISS
Title or Position: OWNER
Credential: PA
Phone: 407-376-4976