Healthcare Provider Details

I. General information

NPI: 1225076284
Provider Name (Legal Business Name): NES OF SOUTHERN FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 OVERSEAS HWY
MARATHON FL
33050-2329
US

IV. Provider business mailing address

PO BOX 550968
TAMPA FL
33655-0968
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-5533
  • Fax: 305-289-0630
Mailing address:
  • Phone: 800-377-8721
  • Fax: 304-523-2241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT MORRA
Title or Position: PRESIDENT, CEO
Credential:
Phone: 800-377-8721