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General NPI Number Information
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NPI Number | 1962444372
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Entity Type | Organization
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Legal Business Name | FLORIDA NEUROLOGY INSTITUTE
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 1324 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-4543
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Country | US
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Telephone | 352-254-0053
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Fax | 352-324-2929
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Provider Business Mailing Address
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Address Line | PO BOX 493235
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City | LEESBURG
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State | FL
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Zip | 34749-3235
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Country | US
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Telephone | 352-254-0233
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Fax | 352-324-2929
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARISOL GONZALEZ
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Credential |
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Telephone | 352-254-0233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME86321
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License Number State | FL
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