Provider Demographics
NPI:1750628186
Name:LIVINGSTON SURGICAL ASSISTING INC
Entity Type:Organization
Organization Name:LIVINGSTON SURGICAL ASSISTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:386-274-5712
Mailing Address - Street 1:PO BOX 730132
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32173-0132
Mailing Address - Country:US
Mailing Address - Phone:386-274-5712
Mailing Address - Fax:386-274-1926
Practice Address - Street 1:800 SHADY OAKS DR APT 300
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2585
Practice Address - Country:US
Practice Address - Phone:386-274-5712
Practice Address - Fax:386-274-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9299567163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty