Avanti Wellness Center Flllp
Clinic/Center in St Augustine, FL. Organization (NPI-2).
NPI number1528200029
StatusActive
Last updated in NPPESAug 18, 2011
Details
- NPI
- 1528200029
- Entity type
- Organization (NPI-2)
- Legal business name
- Avanti Wellness Center Flllp
- Organization subpart
- No
- Enumeration date
- Mar 30, 2009
- Last updated
- Aug 18, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261Q00000X | Clinic/Center | HCC7499 | FL | Yes |
| 208D00000X | General Practice | – | – |
Other names
- Avanti Wellness Center (Doing Business As)
Practice location
3574 Us 1 SSuite 113
St Augustine, FL 32086-6466
Phone 904-797-3115 · Fax 904-797-2915
Mailing address
3574 Us 1 SSuite 113
St Augustine, FL 32086-6466
Phone 904-797-3115 · Fax 904-797-2915
Authorized official
Randi B Brazer
Director Of Operations
9047973115
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