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General NPI Number Information
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NPI Number | 1134018203
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Entity Type | Organization
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Legal Business Name | RADIANCE PAIN INSTITUTE
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 9716 N 56TH ST
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-5508
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Country | US
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Telephone | 813-295-8376
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Fax | 813-295-8476
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Provider Business Mailing Address
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Address Line | 9716 N 56TH ST
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-5508
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Country | US
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Telephone | 813-295-8376
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Fax | 813-295-8476
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENNIFER FRIEND
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Credential |
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Telephone | 813-295-8376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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