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General NPI Number Information
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NPI Number | 1316054513
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Entity Type | Organization
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Legal Business Name | PREMIER FOOT AND ANKLE SPECIALISTS
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 01/16/2021
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Provider Practice Location Address
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Address Line | 414 N BREVARD AVE
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City | ARCADIA
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State | FL
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Zip | 34266-4504
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Country | US
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Telephone | 863-494-3478
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Fax | 863-494-0582
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Provider Business Mailing Address
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Address Line | 712 THE RIALTO
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City | VENICE
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State | FL
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Zip | 34285-3524
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Country | US
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Telephone | 941-488-0222
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Fax | 941-480-1668
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Authorized Official
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Title or Position | CONSULTANT
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Name | NICOLE BAYLINSON
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Credential |
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Telephone | 856-582-6082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO 1580
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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