=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811357536
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW REGENERATION ORTHOPEDICS OF FLORIDA, PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2016
-----------------------------------------------------
Last Update Date | 12/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5630 MARQUESAS CIR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-357-1773
-----------------------------------------------------
Fax | 941-256-7452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5630 MARQUESAS CIR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34233-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-357-1773
-----------------------------------------------------
Fax | 941-256-7452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | ANDREA A GERBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-357-1773
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | OS9810
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------