Healthcare Provider Details

I. General information

NPI: 1932915360
Provider Name (Legal Business Name): OVATION HAND INSTITUTE - FL P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 PALISADES PARK CT STE 8
FORT MYERS FL
33912-7131
US

IV. Provider business mailing address

2593 DEVELOPMENT DR STE 270
GREEN BAY WI
54311-5999
US

V. Phone/Fax

Practice location:
  • Phone: 844-432-1600
  • Fax: 262-302-4075
Mailing address:
  • Phone: 844-432-1600
  • Fax: 262-302-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TARRAH O'DONNELL
Title or Position: OFFICE MANAGER
Credential: PA-C
Phone: 844-432-1600