Provider Demographics
NPI:1659922169
Name:TAMPA BAY SPINE & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:TAMPA BAY SPINE & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-412-8503
Mailing Address - Street 1:32815 US HIGHWAY 19 N STE 200
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3145
Mailing Address - Country:US
Mailing Address - Phone:727-412-8541
Mailing Address - Fax:727-412-8541
Practice Address - Street 1:32815 US HIGHWAY 19 N STE 200
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3145
Practice Address - Country:US
Practice Address - Phone:727-412-8541
Practice Address - Fax:727-412-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty