# THE CLINIC ST PETE

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

## Provider details

- **NPI number:** 1730637877
- **Authorized official:** NICOLE ACKERMAN RN (CEO)
- **Authorized official phone:** (845) 608-3312

## Contact information

- **Practice address:** 4100 5TH AVE N, ST PETERSBURG, FL 33713-6304
- **Practice address phone:** (845) 608-3312
- **Mailing address:** 11 PLAZA REAL S APT 1003, BOCA RATON, FL 33432-4899
- **Mailing address phone:** (845) 608-3312

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | Yes |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/19/2016
- **Last updated:** 09/19/2016