Healthcare Provider Details

I. General information

NPI: 1639132616
Provider Name (Legal Business Name): GULFCOAST SPINE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 W BOY SCOUT BLVD SUITE 400
TAMPA FL
33607-5724
US

IV. Provider business mailing address

4211 W BOY SCOUT BLVD SUITE 400
TAMPA FL
33607-5724
US

V. Phone/Fax

Practice location:
  • Phone: 855-485-3262
  • Fax: 813-443-8255
Mailing address:
  • Phone: 813-443-2108
  • Fax: 813-443-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES JOSEPH RONZO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 813-443-2108