MEDICARE: 360 ORTHO AND SPINE 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	207XS0117X	Orthopaedic Surgery of the Spine Physician

General Provider Information

NPI Number	:	1972062685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	360 ORTHO AND SPINE LLC

Provider Business Mailing Address
First Line	:	8902 N DALE MABRY HWY STE 104
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1579
Country	:	US
Telephone Number	:	833-367-4968
Fax Number	:	833-367-4968

Provider Business Practice Location Address
First Line	:	8902 N DALE MABRY HWY STE 104
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-1579
Country	:	US
Telephone Number	:	833-367-4968
Fax Number	:	833-367-4968

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MELISSA WATKINS
Credential	:
Telephone Number	:	833-367-4968

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	05/04/2026

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Directions to “360 ORTHO AND SPINE LLC ” Practice Location

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