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General NPI Number Information
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NPI Number | 1104621663
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Entity Type | Organization
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Legal Business Name | OCEAN TREIS MEDICAL, LLC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 442 W KENNEDY BLVD STE 260
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City | TAMPA
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State | FL
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Zip | 33606-1464
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Country | US
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Telephone | 833-336-2326
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1857
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City | RUSKIN
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State | FL
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Zip | 33575-1857
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NETTIE CRISCIO
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Credential |
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Telephone | 833-336-2326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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