Healthcare Provider Details

I. General information

NPI: 1295277911
Provider Name (Legal Business Name): FLORIDA UROLOGY SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2016
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S SCHOOL AVE SUITE 200
SARASOTA FL
34237-6014
US

IV. Provider business mailing address

1 S SCHOOL AVE SUITE 200
SARASOTA FL
34237-6014
US

V. Phone/Fax

Practice location:
  • Phone: 941-309-7000
  • Fax: 941-309-7009
Mailing address:
  • Phone: 941-309-7000
  • Fax: 941-309-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME0059349
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberME0045454
License Number StateFL

VIII. Authorized Official

Name: WILLIAM J TINGLE
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 941-309-7000