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General NPI Number Information
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NPI Number | 1154875284
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Entity Type | Organization
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Legal Business Name | SPINE INSTITUTE OF FLORIDA, PLLC
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 6536 GUNN HWY
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City | TAMPA
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State | FL
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Zip | 33625-3853
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Country | US
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Telephone | 813-803-0029
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Fax |
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Provider Business Mailing Address
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Address Line | 7702 STILL PARK CIR
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City | ODESSA
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State | FL
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Zip | 33556-2263
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Country | US
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Telephone | 727-637-8520
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Fax | 813-949-8919
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Authorized Official
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Title or Position | DO
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Name | MARK NICHOLAS PERENICH
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Credential |
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Telephone | 813-803-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | OS14036
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License Number State | FL
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