Healthcare Provider Details

I. General information

NPI: 1669232716
Provider Name (Legal Business Name): OWN SLEEP MEDICINE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 CENTRAL AVE STE 800
ST PETERSBURG FL
33701-3984
US

IV. Provider business mailing address

360 CENTRAL AVE STE 800
ST PETERSBURG FL
33701-3984
US

V. Phone/Fax

Practice location:
  • Phone: 833-777-1069
  • Fax: 833-777-2969
Mailing address:
  • Phone: 833-777-1069
  • Fax: 833-777-2969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NOLAN CLINT HOOPER
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 833-777-1069