Healthcare Provider Details

I. General information

NPI: 1922392422
Provider Name (Legal Business Name): COMPASS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GORE ST SUITE 607
ORLANDO FL
32806-1044
US

IV. Provider business mailing address

100 W GORE ST STE 406
ORLANDO FL
32806-1049
US

V. Phone/Fax

Practice location:
  • Phone: 407-210-1320
  • Fax: 321-202-2583
Mailing address:
  • Phone: 407-210-1320
  • Fax: 321-202-2583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA OLDENBURG
Title or Position: PRACTICE
Credential:
Phone: 407-210-1320