Healthcare Provider Details

I. General information

NPI: 1518364611
Provider Name (Legal Business Name): INGROWN NAIL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8554 PALM PKWY
ORLANDO FL
32836-6432
US

IV. Provider business mailing address

55 W CHURCH ST APT. 2601
ORLANDO FL
32801-4931
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-3336
  • Fax:
Mailing address:
  • Phone: 561-504-2197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO1823
License Number StateFL

VIII. Authorized Official

Name: DR. JAY RUST
Title or Position: OWNER
Credential: DPM
Phone: 386-274-3336