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General NPI Number Information
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NPI Number | 1417545088
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Entity Type | Organization
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Legal Business Name | NEXUS SPINE INSTITUTE, LLC
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 10676 BLOOMINGDALE AVE STE 3
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City | RIVERVIEW
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State | FL
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Zip | 33578-4292
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Country | US
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Telephone | 813-358-3578
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Fax |
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Provider Business Mailing Address
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Address Line | 107 N 11TH ST # 508
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City | TAMPA
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State | FL
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Zip | 33602-4242
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Country | US
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Telephone | 813-358-3578
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MISS HEATHER M TRAVIS
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Credential |
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Telephone | 813-358-3578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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License Number State |
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