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General NPI Number Information
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NPI Number | 1114447521
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE SURGICAL SPECIALISTS
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 09/09/2019
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Provider Practice Location Address
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Address Line | 8142 BELLARUS WAY STE 101
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City | TRINITY
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State | FL
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Zip | 34655-1799
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Country | US
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Telephone | 727-274-1330
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Fax | 855-274-0039
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Provider Business Mailing Address
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Address Line | 8142 BELLARUS WAY STE 101
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City | TRINITY
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State | FL
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Zip | 34655-1799
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Country | US
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Telephone | 727-274-1330
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Fax | 855-274-0039
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | TIFFANI SHELTON
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Credential | DO
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Telephone | 727-274-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS13410
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License Number State | FL
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