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General NPI Number Information
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NPI Number | 1760758643
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Entity Type | Organization
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Legal Business Name | SUNSHINE ASSISTANT LLC
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 6308 PROMINENCE POINT DRIVE
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City | LAKELAND
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State | FL
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Zip | 33813-4491
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Country | US
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Telephone | 813-376-3491
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Fax | 813-376-3491
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Provider Business Mailing Address
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Address Line | 6308 PROMINENCE POINT DRIVE
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City | LAKELAND
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State | FL
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Zip | 33813-4491
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Country | US
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Telephone | 813-376-3491
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Fax | 813-376-3491
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALBERTO NUNEZ
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Credential | PA
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Telephone | 813-376-3491
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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 | PA9101680
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License Number State | FL
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