Provider Demographics
NPI:1316092331
Name:FLORIDAY FIXATION, INC.
Entity type:Organization
Organization Name:FLORIDAY FIXATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:WOMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:321-288-5605
Mailing Address - Street 1:4740 SMITHFIELD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7864
Mailing Address - Country:US
Mailing Address - Phone:321-288-5605
Mailing Address - Fax:321-242-8415
Practice Address - Street 1:4740 SMITHFIELD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7864
Practice Address - Country:US
Practice Address - Phone:321-288-5605
Practice Address - Fax:321-242-8415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3180082163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY100BOtherBLUE CROSS BLUE SHIELD