Healthcare Provider Details

I. General information

NPI: 1215233184
Provider Name (Legal Business Name): SUNSHINE SPINE AND PAIN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4788 HODGES BLVD STE 105
JACKSONVILLE FL
32224-7223
US

IV. Provider business mailing address

PO BOX 919327
ORLANDO FL
32891-9327
US

V. Phone/Fax

Practice location:
  • Phone: 904-651-8206
  • Fax: 904-900-2221
Mailing address:
  • Phone: 904-651-8206
  • Fax: 904-900-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME84002
License Number StateFL

VIII. Authorized Official

Name: SAMKA KURDIJA
Title or Position: GM
Credential:
Phone: 904-525-2403