MEDICARE: ADVANCED NEUROSURGICAL TECHNOLOGIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1053017673
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED NEUROSURGICAL TECHNOLOGIES

Provider Business Mailing Address
First Line	:	52 RILEY RD # 213
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-5420
Country	:	US
Telephone Number	:	408-431-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	13563 NARCOOSSEE RD STE 110
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-7138
Country	:	US
Telephone Number	:	407-691-6912
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. JOHANNA C TORRES
Credential	:	RN
Telephone Number	:	408-431-1200

Provider Enumeration Date	:	02/06/2023
Last Update Date	:	01/02/2024

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