Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Alliance Regenerative and Performance Medicine, PLLC

Organization Sports Medicine (Family Medicine) Physician · NPI 1104418292

Alliance Regenerative and Performance Medicine, PLLC provides Sports Medicine (Family Medicine) Physician services in St Petersburg, Florida. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

111 2nd Ave NE Ste 1401
St Petersburg, FL 33701-3480
Phone: (727) 258-7224
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Family Medicine) Physician (primary) Taxonomy 207QS0010X

Record details

NPI number1104418292
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Broussard — Owner · (727) 258-7224
NPI enumeratedFebruary 9, 2021
Last updated in NPPESFebruary 9, 2021
Certification dateFebruary 9, 2021
Mailing address111 2nd Ave Ne Ste 1401, St Petersburg, FL 33701-3480

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