Healthcare Provider Details

I. General information

NPI: 1760231120
Provider Name (Legal Business Name): CENTER FOR NEUROLOGICAL SURGERY AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6919 N DALE MABRY HWY STE 325
TAMPA FL
33614-3860
US

IV. Provider business mailing address

42 BUSINESS CENTRE DR UNIT 310
MIRAMAR BEACH FL
32550-6995
US

V. Phone/Fax

Practice location:
  • Phone: 516-507-0800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: CARIANNE YANTZ
Title or Position: ASST ADMIN
Credential:
Phone: 561-507-0800