Healthcare Provider Details

I. General information

NPI: 1720401516
Provider Name (Legal Business Name): RLB SURGICAL ASSISTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7149 COLUMNS CIR APT 102
TRINITY FL
34655-3660
US

IV. Provider business mailing address

7149 COLUMNS CIR APT 102
TRINITY FL
34655-3660
US

V. Phone/Fax

Practice location:
  • Phone: 727-494-6863
  • Fax: 727-807-9758
Mailing address:
  • Phone: 727-494-6863
  • Fax: 727-807-9758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGER BARNARD
Title or Position: CEO
Credential: CSFA
Phone: 727-494-6863