MEDICARE: PANOPTIC COLLECTIVE 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	:	1568255255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANOPTIC COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	4057 IRIS ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33703-5639
Country	:	US
Telephone Number	:	941-993-9649
Fax Number	:

Provider Business Practice Location Address
First Line	:	5517 21ST AVE W STE F
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-5604
Country	:	US
Telephone Number	:	941-896-9746
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JANE PASIENZA
Credential	:
Telephone Number	:	941-993-9649

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	05/26/2025

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