Basic Information
| Provider Information | |||||||||
| NPI: | 1023320900 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETRINEC | ||||||||
| FirstName: | NICHOLAS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 39 PALM DR | ||||||||
| Address2: | |||||||||
| City: | KEY WEST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330406117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488848503 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5900 COLLEGE RD | ||||||||
| Address2: | |||||||||
| City: | KEY WEST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330404342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052945531 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2010 | ||||||||
| LastUpdateDate: | 01/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 5101020842 | MI | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | OS17436 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.