Provider Demographics
NPI:1780204602
Name:PINNACLE FOOT AND ANKLE CENTERS, LLC
Entity Type:Organization
Organization Name:PINNACLE FOOT AND ANKLE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MATRECE
Authorized Official - Last Name:GREEN-WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-742-7118
Mailing Address - Street 1:1801 SE HILLMOOR DR STE A-103
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7545
Mailing Address - Country:US
Mailing Address - Phone:772-742-7118
Mailing Address - Fax:772-228-6893
Practice Address - Street 1:1801 SE HILLMOOR DR STE A-103
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7545
Practice Address - Country:US
Practice Address - Phone:407-844-4499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty