Healthcare Provider Details

I. General information

NPI: 1174040828
Provider Name (Legal Business Name): GULFCOAST SPINE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 MILLENIA BLVD STE 300
ORLANDO FL
32839-6407
US

IV. Provider business mailing address

4211 W BOY SCOUT BLVD STE 400
TAMPA FL
33607-5766
US

V. Phone/Fax

Practice location:
  • Phone: 813-443-2108
  • Fax: 813-284-7952
Mailing address:
  • Phone: 813-443-2108
  • Fax: 813-284-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES J RONZO
Title or Position: OWNER
Credential: DO
Phone: 813-443-2108