Provider Demographics
NPI:1275231466
Name:ADVANCED JOINT AND SPINE INSTITUTE-ORLANDO, LLC
Entity Type:Organization
Organization Name:ADVANCED JOINT AND SPINE INSTITUTE-ORLANDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KASTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-256-0933
Mailing Address - Street 1:206 CANOVA DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-2669
Mailing Address - Country:US
Mailing Address - Phone:407-256-0933
Mailing Address - Fax:
Practice Address - Street 1:7974 LAKE UNDERHILL ROAD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822
Practice Address - Country:US
Practice Address - Phone:407-256-0933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical