Healthcare Provider Details

I. General information

NPI: 1659707248
Provider Name (Legal Business Name): NSI PHYSICIAN'S ASSISTANTS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2706 REW CIR STE 100
OCOEE FL
34761-4215
US

IV. Provider business mailing address

2706 REW CIR STE 100
OCOEE FL
34761-4215
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-8585
  • Fax: 407-649-0151
Mailing address:
  • Phone: 407-649-8585
  • Fax: 407-649-0151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9104892
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT L. MASSON
Title or Position: CEO
Credential: M.D.
Phone: 407-649-8585