Provider Demographics
NPI:1417294158
Name:FLORIDA NERVE MED LLC
Entity Type:Organization
Organization Name:FLORIDA NERVE MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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 1:741 DUCHESS CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1553
Mailing Address - Country:US
Mailing Address - Phone:561-602-6191
Mailing Address - Fax:
Practice Address - Street 1:8198 S JOG RD
Practice Address - Street 2:#100
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2900
Practice Address - Country:US
Practice Address - Phone:561-602-6191
Practice Address - Fax:561-429-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96190204R00000X, 2084N0008X, 2084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Single Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME96190OtherMEDICAL LICENSE