Provider Demographics
NPI:1154875284
Name:SPINE INSTITUTE OF FLORIDA, PLLC
Entity type:Organization
Organization Name:SPINE INSTITUTE OF FLORIDA, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:PERENICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-803-0029
Mailing Address - Street 1:7702 STILL PARK CIR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2263
Mailing Address - Country:US
Mailing Address - Phone:727-637-8520
Mailing Address - Fax:813-949-8919
Practice Address - Street 1:6536 GUNN HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33625-3853
Practice Address - Country:US
Practice Address - Phone:813-803-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14036207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty