Beyond The Body Wellness LLC
Nurse Practitioner, Primary Care in Lehigh Acres, FL. Organization (NPI-2).
NPI number1194473751
StatusActive
Last updated in NPPESMar 14, 2022
Details
- NPI
- 1194473751
- Entity type
- Organization (NPI-2)
- Legal business name
- Beyond The Body Wellness LLC
- Organization subpart
- No
- Enumeration date
- Mar 14, 2022
- Certification date
- Feb 28, 2022
- Last updated
- Mar 14, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP2300X | Nurse Practitioner, Primary Care | – | – | Yes |
Practice location
1121 Homestead Rd N Ste 279Lehigh Acres, FL 33936-6038
Phone 765-432-7195
Mailing address
1121 Homestead Rd N Ste 279Lehigh Acres, FL 33936-6038
Phone 765-432-7195
Other practice locations
4403 E 19th St
Lehigh Acres, FL 33972-1400
Lehigh Acres, FL 33972-1400
Phone 765-432-7195
Authorized official
Dedra D Coop
NP/President
7654327195
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