| Sun Miracle Wellness Center LLC | |
|
13575 58th St N Ste 200 Clearwater FL 33760-3739 | |
| (727) 741-8475 | |
| Not Available |
| Full Name | Sun Miracle Wellness Center LLC |
|---|---|
| Speciality | Nurse Practitioner - Adult Health |
| Location | 13575 58th St N Ste 200, Clearwater, Florida |
| Authorized Official Name and Position | Shanta K Davis (OWNER) |
| Authorized Official Contact | 7277418475 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sun Miracle Wellness Center LLC 6740 Crosswinds Dr N Ste C St Petersburg FL 33710-5472 Ph: (727) 954-0010 | Sun Miracle Wellness Center LLC 13575 58th St N Ste 200 Clearwater FL 33760-3739 Ph: (727) 741-8475 |
| NPI Number | 1164130613 |
|---|---|
| Provider Enumeration Date | 11/14/2022 |
| Last Update Date | 09/25/2023 |
| Certification Date | 09/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164130613 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| 363LA2200X | Nurse Practitioner - Adult Health | () | Primary |
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