Provider Demographics
NPI:1760193825
Name:FLAMINGO FOOT AND ANKLE PA
Entity Type:Organization
Organization Name:FLAMINGO FOOT AND ANKLE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:754-206-4753
Mailing Address - Street 1:3051 NE 41ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5801
Mailing Address - Country:US
Mailing Address - Phone:954-594-2610
Mailing Address - Fax:
Practice Address - Street 1:4801 N FEDERAL HWY STE 101
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4618
Practice Address - Country:US
Practice Address - Phone:954-594-2610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1326692781OtherINDIVIDUAL NPI