# NISSY SURGICAL 1ST ASSIST LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134584519
- **Authorized official:** RODRIGUE TERTUS (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (954) 416-1781

## Contact information

- **Practice address:** 10752 EMILIA ISLES TER, BOYNTON BEACH, FL 33473-4965
- **Practice address phone:** (954) 416-1781
- **Mailing address:** 10752 EMILIA ISLES TER, BOYNTON BEACH, FL 33473-4965

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | PA9107169 | FL | Yes |

## Other

- **Enumeration date:** 12/29/2015
- **Last updated:** 12/29/2015