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General NPI Number Information
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NPI Number | 1609184258
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Entity Type | Organization
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Legal Business Name | SUNCOAST SURGICAL ASSISTING OF FL, INC.
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/16/2010
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Provider Practice Location Address
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Address Line | 17362 PINTO LN.
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City | BROOKSVILLE
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State | FL
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Zip | 34604-9066
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Country | US
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Telephone | 352-796-2791
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Fax | 352-686-7154
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Provider Business Mailing Address
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Address Line | 17362 PINTO LN.
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City | BROOKSVILLE
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State | FL
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Zip | 34604-9066
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Country | US
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Telephone | 352-796-2791
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Fax | 352-686-7154
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SEAN D. BONNER
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Credential | PA
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Telephone | 352-796-2791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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