| Prana Blu Medspa | |
|
1200 S Highland Ave Suite 'b' Clearwater FL 33756-4334 | |
| (727) 330-7733 | |
| (727) 447-6008 |
| Full Name | Prana Blu Medspa |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1200 S Highland Ave, Clearwater, Florida |
| Authorized Official Name and Position | Bethzali Del C. Phillips (MANAGING MEMEBER) |
| Authorized Official Contact | 7273307733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prana Blu Medspa 1200 S Highland Ave Suite 'b' Clearwater FL 33756-4334 Ph: (727) 330-7733 | Prana Blu Medspa 1200 S Highland Ave Suite 'b' Clearwater FL 33756-4334 Ph: (727) 330-7733 |
| NPI Number | 1396014536 |
|---|---|
| Provider Enumeration Date | 12/16/2011 |
| Last Update Date | 12/16/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396014536 | NPI | - | NPPES |
| 1851697056 | Other | FL | PROVIDER NPI |
| 278958500 | Medicaid | FL | |
| P00945853 | Other | FL | PROVIDER PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | ME86204 (Florida) | Primary |
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