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Organization
OBSIDIAN SURGICAL SERVICES, LLC
Active
Organization
OBSIDIAN SURGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEE R MCNIFF (CEO)
(352) 514-3413
Entity
Organization
Contact information
Practice address
3319 MARBLE CREST DR, LAND O LAKES, FL 34638-6082
(352) 514-3413
Mailing address
3319 MARBLE CREST DR, LAND O LAKES, FL 34638-6082
(352) 514-3413
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
NULL
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
06/19/2021
Last updated
06/19/2021
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