Healthcare Provider Details

I. General information

NPI: 1104571629
Provider Name (Legal Business Name): NEXUS SPINE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12437 BRANTLEY COMMONS CT
FORT MYERS FL
33907-5682
US

IV. Provider business mailing address

9858 CLINT MOORE RD # C111-274
BOCA RATON FL
33496-1034
US

V. Phone/Fax

Practice location:
  • Phone: 800-835-9007
  • Fax: 239-310-6649
Mailing address:
  • Phone: 561-482-1144
  • Fax: 561-482-1145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: ABEL MURILLO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 800-835-9007