Organization
THE CLINIC ST PETE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE ACKERMAN RN (CEO)
(845) 608-3312
Entity
Organization
Contact information
Practice address
4100 5TH AVE N, ST PETERSBURG, FL 33713-6304
(845) 608-3312
Mailing address
11 PLAZA REAL S APT 1003, BOCA RATON, FL 33432-4899
(845) 608-3312
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
09/19/2016
Last updated
09/19/2016
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