Organization
TRAUMA & SPECIALTY SURGERY INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI JAZAREVIC (OFFICE MANAGER)
(772) 233-6166
Entity
Organization
Contact information
Practice address
311 N CLYDE MORRIS BLVD STE 440, DAYTONA BEACH, FL 32114-2757
(386) 252-0688
(386) 675-6401
Mailing address
1076 FERN TRL, WAYNESVILLE, NC 28786-9706
(772) 233-6166
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME 65570
FL
2086S0102X
Surgical Critical Care Physician
ME65570
FL
2086S0127X
Trauma Surgery Physician
ME65570
FL
2086S0129X
Vascular Surgery Physician
ME65570
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME 65570
MEDICAL LICENSE
FL
Enumeration date
03/15/2007
Last updated
05/21/2021
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