Organization
CENTRAL FLORIDA PAIN & SPINE INSTITUTE P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROCHELLE R CANNON (ADMINISTRATOR)
(386) 274-0097
Entity
Organization
Contact information
Practice address
725 W GRANADA BLVD, UNIT #22, ORMOND BEACH, FL 32174-5107
(386) 274-0097
(386) 274-4996
Mailing address
PO BOX 731618, ORMOND BEACH, FL 32173-1618
(386) 274-0097
(386) 274-4996
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
ME86188
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578507893
INDIVIDUAL NPI NUMBER
—
01
—
ME86188
FL MEDICAL LIC #
FL
Enumeration date
05/04/2007
Last updated
03/07/2023
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