Healthcare Provider Details

I. General information

NPI: 1063908200
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALTIES OF WEST FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 4TH ST SW
LARGO FL
33770-3515
US

IV. Provider business mailing address

561 4TH ST SW
LARGO FL
33770-3515
US

V. Phone/Fax

Practice location:
  • Phone: 727-433-1461
  • Fax: 727-433-1461
Mailing address:
  • Phone: 727-433-1461
  • Fax: 727-433-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. DONNA GAIL HOWARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-433-1461