MEDICARE: FLORIDA NERVE MED 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	2084N0600X	Clinical Neurophysiology Physician	ME96190	FL
2	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	ME96190	FL
3	204R00000X	Electrodiagnostic Medicine Physician	ME96190	FL
4	2084N0400X	Neurology Physician	ME96190	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME96190	OTHER	FL	MEDICAL LICENSE

General Provider Information

NPI Number	:	1417294158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA NERVE MED LLC

Provider Business Mailing Address
First Line	:	741 DUCHESS CT
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-1553
Country	:	US
Telephone Number	:	561-602-6191
Fax Number	:

Provider Business Practice Location Address
First Line	:	8198 S JOG RD
Second Line	:	#100
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2900
Country	:	US
Telephone Number	:	561-602-6191
Fax Number	:	561-429-3630

Authorized Official
Title or Position	:	OWNER
Name	:	HILDEGARDE GEISSE
Credential	:	M.D.
Telephone Number	:	561-310-7759

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	03/16/2015

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Directions to “FLORIDA NERVE MED LLC ” Practice Location

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