Provider Demographics
NPI:1053790717
Name:FLORIDA NERVE MED, LLC
Entity type:Organization
Organization Name:FLORIDA NERVE MED, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILDEGARDE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEISSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-310-7759
Mailing Address - Street 1:6400 N ANDREWS AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2114
Mailing Address - Country:US
Mailing Address - Phone:844-636-3876
Mailing Address - Fax:561-429-3630
Practice Address - Street 1:6400 N ANDREWS AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2114
Practice Address - Country:US
Practice Address - Phone:844-636-3876
Practice Address - Fax:561-429-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96190332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL145ZCOtherBCBS
FL6985656OtherCIGNA
FL331981OtherAVMED
FL9711158OtherAETNA
FL46-1674338OtherUHC
FL6985656OtherCIGNA