Healthcare Provider Details

I. General information

NPI: 1619442209
Provider Name (Legal Business Name): FAMILY SPINE AND PAIN CARE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 TAMIAMI TRL S STE 601
VENICE FL
34285-3568
US

IV. Provider business mailing address

2338 IMMOKALEE RD # 203
NAPLES FL
34110-1445
US

V. Phone/Fax

Practice location:
  • Phone: 231-638-1853
  • Fax:
Mailing address:
  • Phone: 231-638-1853
  • Fax: 239-790-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TATIANA ROBLES
Title or Position: PRACTICE ADMIN
Credential:
Phone: 239-300-0987