Provider Demographics
NPI:1346594868
Name:SUNSHINE STATE PHYSICIANS GROUP, LLC
Entity Type:Organization
Organization Name:SUNSHINE STATE PHYSICIANS GROUP, LLC
Other - Org Name:SUNSHINE STATE PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, BSHA
Authorized Official - Phone:407-857-8679
Mailing Address - Street 1:9753 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7841
Mailing Address - Country:US
Mailing Address - Phone:407-857-8679
Mailing Address - Fax:407-857-8672
Practice Address - Street 1:9753 S ORANGE BLOSSOM TRL
Practice Address - Street 2:SUITE 103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7841
Practice Address - Country:US
Practice Address - Phone:407-857-8679
Practice Address - Fax:407-857-8672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10505111N00000X
FLME50492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty