Provider Demographics
NPI:1821336413
Name:INDEPENDENT SURGICAL ASSIST INC
Entity Type:Organization
Organization Name:INDEPENDENT SURGICAL ASSIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENSETH
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:1608-438-0551
Mailing Address - Street 1:1451 HOHE LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9330
Mailing Address - Country:US
Mailing Address - Phone:608-438-0551
Mailing Address - Fax:
Practice Address - Street 1:1451 HOHE LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9330
Practice Address - Country:US
Practice Address - Phone:608-438-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9341144363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty