Healthcare Provider Details

I. General information

NPI: 1811422249
Provider Name (Legal Business Name): NRSA GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9360 BALM RIVERVIEW RD
RIVERVIEW FL
33569-5104
US

IV. Provider business mailing address

4700 N HABANA AVE STE 202
TAMPA FL
33614-7150
US

V. Phone/Fax

Practice location:
  • Phone: 813-333-1353
  • Fax: 813-333-2383
Mailing address:
  • Phone: 813-333-1353
  • Fax: 813-333-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: NOMEN AZEEM
Title or Position: OWNER
Credential: MD
Phone: 703-303-4354