Provider Demographics
NPI:1346590080
Name:NBO MEDICAL OF FLORIDA, LLC
Entity Type:Organization
Organization Name:NBO MEDICAL OF FLORIDA, LLC
Other - Org Name:NBO MEDICAL OF FLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-614-6379
Mailing Address - Street 1:90 CYPRESS WAY E STE 60
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9275
Mailing Address - Country:US
Mailing Address - Phone:800-337-4818
Mailing Address - Fax:
Practice Address - Street 1:90 CYPRESS WAY E STE 60
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-9275
Practice Address - Country:US
Practice Address - Phone:800-337-4818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS 10008OtherMEDICAL LICENSE
FLARNP 9252175OtherMEDICAL LICENSE
FLPT 23764OtherMEDICAL LICENSE