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General NPI Number Information
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NPI Number | 1760193825
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Entity Type | Organization
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Legal Business Name | FLAMINGO FOOT AND ANKLE PA
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 4801 N FEDERAL HWY STE 101
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4618
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Country | US
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Telephone | 954-594-2610
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Fax |
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Provider Business Mailing Address
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Address Line | 3051 NE 41ST ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-5801
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Country | US
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Telephone | 954-594-2610
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Fax |
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Authorized Official
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Title or Position | FOUNDER AND CEO
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Name | DR. STEPHANIE TINE
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Credential | DPM
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Telephone | 754-206-4753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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