Healthcare Provider Details

I. General information

NPI: 1336457084
Provider Name (Legal Business Name): ABDOMINAL PAIN SOLUTIONS OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 OAKWATER CIR
ORLANDO FL
32806-6257
US

IV. Provider business mailing address

5700 MIDNIGHT PASS RD ST. 4
SARASOTA FL
34242-3083
US

V. Phone/Fax

Practice location:
  • Phone: 407-438-9533
  • Fax:
Mailing address:
  • Phone: 888-337-3509
  • Fax: 941-328-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. CARL RICHARDSON NOBACK
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 888-337-3509