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General NPI Number Information
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NPI Number | 1144037482
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Entity Type | Organization
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Legal Business Name | FLORIDA ENDOVASCULAR ASSOCIATES LLC
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 360 CENTRAL AVE STE 800
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-3984
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Country | US
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Telephone | 713-575-3686
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Fax | 713-575-3688
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Provider Business Mailing Address
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Address Line | 50 N LAURA ST STE 2500
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3646
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Country | US
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Telephone | 713-575-3686
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SEAN M. MULLEN
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Credential |
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Telephone | 347-886-4420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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