Provider Demographics
NPI:1104621663
Name:OCEAN TREIS MEDICAL, LLC
Entity type:Organization
Organization Name:OCEAN TREIS MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NETTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-336-2326
Mailing Address - Street 1:PO BOX 1857
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-1857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:442 W KENNEDY BLVD STE 260
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1464
Practice Address - Country:US
Practice Address - Phone:833-336-2326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty