| Entity Name: | CENTER FOR NEUROLOGICAL SURGERY AMERICA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Mar 2024 (10 months ago) |
| Document Number: | P24000021017 |
| Address: | 42 BUSINESS CENTRE DR, SUIITE 310, MIRAMAR BEACH, FL, 32550, UN |
| Mail Address: | 42 BUSINESS CENTRE DR, SUIITE 310, MIRAMAR BEACH, FL, 32550, UN |
| ZIP code: | 32550 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760231120 | 2024-05-16 | 2024-05-16 | 42 BUSINESS CENTRE DR UNIT 310, MIRAMAR BEACH, FL, 325506995, US | 6919 N DALE MABRY HWY STE 325, TAMPA, FL, 336143860, US | |||||||||||||
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| Phone | +1 516-507-0800 |
Authorized person
| Name | CARIANNE YANTZ |
| Role | ASST ADMIN |
| Phone | 5615070800 |
Taxonomy
| Taxonomy Code | 207XS0117X - Orthopaedic Surgery of the Spine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GLICKMAN SCOTT G | Agent | 817 BOULEVARD OF CHAMPIONS, SHALIMAR, FL, 32579 |
| Name | Role | Address |
|---|---|---|
| GLICKMAN SCOTT G | President | 817 BOULEVARD OF THE CHAMPIONS, SHALIMAR, FL, 32579 |
| Name | Date |
|---|---|
| Domestic Profit | 2024-03-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
