Provider Demographics
NPI:1568255255
Name:PANOPTIC COLLECTIVE LLC
Entity type:Organization
Organization Name:PANOPTIC COLLECTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PASIENZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-993-9649
Mailing Address - Street 1:4057 IRIS ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5639
Mailing Address - Country:US
Mailing Address - Phone:941-993-9649
Mailing Address - Fax:
Practice Address - Street 1:5517 21ST AVE W STE F
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-5604
Practice Address - Country:US
Practice Address - Phone:941-896-9746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty