Provider Demographics
NPI:1396458329
Name:FLORIDA NEUROSURGERY AND SPINE CENTER PA
Entity type:Organization
Organization Name:FLORIDA NEUROSURGERY AND SPINE CENTER PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT; OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-353-2055
Mailing Address - Street 1:155 CRYSTAL BEACH DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3588
Mailing Address - Country:US
Mailing Address - Phone:850-353-2055
Mailing Address - Fax:855-344-6080
Practice Address - Street 1:155 CRYSTAL BEACH DR STE 200
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3588
Practice Address - Country:US
Practice Address - Phone:850-353-2055
Practice Address - Fax:855-344-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty