Provider Demographics
NPI:1306015672
Name:ACUSPA, PA
Entity Type:Organization
Organization Name:ACUSPA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DIPPENWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LIC ACUPUNCTURISTS
Authorized Official - Phone:321-303-5946
Mailing Address - Street 1:3722 S CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7608
Mailing Address - Country:US
Mailing Address - Phone:321-303-5946
Mailing Address - Fax:407-816-8797
Practice Address - Street 1:3722 S CONWAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7608
Practice Address - Country:US
Practice Address - Phone:321-303-5946
Practice Address - Fax:407-816-8797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2518305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service