Healthcare Provider Details

I. General information

NPI: 1306004130
Provider Name (Legal Business Name): AMBULATORY ANKLE AND FOOT CARE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 W PLAZA DR
TALLAHASSEE FL
32308-5324
US

IV. Provider business mailing address

1608 W PLAZA DR
TALLAHASSEE FL
32308-5324
US

V. Phone/Fax

Practice location:
  • Phone: 850-942-2400
  • Fax: 850-942-7714
Mailing address:
  • Phone: 850-942-2400
  • Fax: 850-942-7714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateFL

VIII. Authorized Official

Name: NANCY NELL FLESHER
Title or Position: PRESIDENT
Credential:
Phone: 850-942-2400