Healthcare Provider Details

I. General information

NPI: 1285182659
Provider Name (Legal Business Name): FLORIDA PAIN SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 SOUTHPOINT DR E STE 1
JACKSONVILLE FL
32216-8710
US

IV. Provider business mailing address

4100 SOUTHPOINT DR E STE 1
JACKSONVILLE FL
32216-8710
US

V. Phone/Fax

Practice location:
  • Phone: 46-475-2669
  • Fax: 904-770-5594
Mailing address:
  • Phone: 46-475-2669
  • Fax: 904-770-5594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPA9105187
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberME117856
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET ROBERTS
Title or Position: ADMINISTRATOR
Credential:
Phone: 904-509-8739