Organization
TAMPA PAIN RELIEF CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS NICOLE GALLIVAN (CREDENTIALING SPECIALIST)
(727) 755-0693
Entity
Organization
Contact information
Practice address
403 S KINGS AVE, SUITE 201, BRANDON, FL 33511-5905
(727) 755-0693
(727) 755-0679
Mailing address
311 PARK PLACE BLVD, 5TH FLOOR, CLEARWATER, FL 33759-4904
(727) 755-0693
(727) 755-0679
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME89547
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
262580600
—
FL
Enumeration date
09/18/2015
Last updated
08/02/2016
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