Provider Demographics
NPI:1144037482
Name:FLORIDA ENDOVASCULAR ASSOCIATES LLC
Entity type:Organization
Organization Name:FLORIDA ENDOVASCULAR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-886-4420
Mailing Address - Street 1:50 N LAURA ST STE 2500
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3646
Mailing Address - Country:US
Mailing Address - Phone:713-575-3686
Mailing Address - Fax:
Practice Address - Street 1:360 CENTRAL AVE STE 800
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3984
Practice Address - Country:US
Practice Address - Phone:713-575-3686
Practice Address - Fax:713-575-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty