Organization
SE ORTHOPEDIC SPECIALISTS
Active
Organization
SE ORTHOPEDIC SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE SISKO (CREDENTIALING SPECIALIST)
(727) 755-0693
Entity
Organization
Contact information
Practice address
2300 PARK AVE, SUITE 203, ORANGE PARK, FL 32073-5571
(727) 755-0693
(727) 755-0679
Mailing address
PO BOX 9830, SALT LAKE CITY, UT 84109-9830
(727) 755-0693
(727) 755-0679
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME80485
FL
Other
Enumeration date
12/30/2015
Last updated
12/30/2015
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