Intentionally Well, Llc | |
3716 Sw Moore St Palm City FL 34990-5647 | |
(772) 215-9946 | |
Not Available |
Full Name | Intentionally Well, Llc |
---|---|
Speciality | Nurse Practitioner - Family |
Location | 3716 Sw Moore St, Palm City, Florida |
Authorized Official Name and Position | Theresa Anne Pinder (SOLE MEMBER, CEO) |
Authorized Official Contact | 7722159946 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Intentionally Well, Llc 3716 Sw Moore St Palm City FL 34990-5647 Ph: (772) 215-9946 | Intentionally Well, Llc 3716 Sw Moore St Palm City FL 34990-5647 Ph: (772) 215-9946 |
NPI Number | 1922426402 |
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Provider Enumeration Date | 04/02/2014 |
Last Update Date | 04/02/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922426402 | NPI | - | NPPES |
1912256538 | Other | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | ME69414 (Florida) | Secondary |
363LF0000X | Nurse Practitioner - Family | 1476272 (Florida) | Primary |
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