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General NPI Number Information
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NPI Number | 1457458317
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA ORTHOPAEDIC SURGERY ASSOCIATES PL
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 2000 E EDGEWOOD DR SUITE 112
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City | LAKELAND
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State | FL
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Zip | 33803-3653
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Country | US
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Telephone | 863-666-3436
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Fax | 863-667-3550
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Provider Business Mailing Address
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Address Line | 2000 E EDGEWOOD DR SUITE 112
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City | LAKELAND
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State | FL
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Zip | 33803-3653
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Country | US
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Telephone | 863-666-3436
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Fax | 863-667-3550
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. VICKI SUE SHARPE
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Credential | CPC
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Telephone | 863-666-3436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME76265
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License Number State | FL
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