MEDICARE: OCEAN TREIS MEDICAL, LLC

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	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1104621663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN TREIS MEDICAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1857
Second Line	:
City	:	RUSKIN
State	:	FL
Zip	:	33575-1857
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	442 W KENNEDY BLVD STE 260
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1464
Country	:	US
Telephone Number	:	833-336-2326
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NETTIE CRISCIO
Credential	:
Telephone Number	:	833-336-2326

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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