Healthcare Provider Details

I. General information

NPI: 1922472000
Provider Name (Legal Business Name): VIBRANCE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W CENTRAL PKWY
ALTAMONTE SPRINGS FL
32714-2415
US

IV. Provider business mailing address

460 W CENTRAL PKWY
ALTAMONTE SPRINGS FL
32714-2415
US

V. Phone/Fax

Practice location:
  • Phone: 407-682-7111
  • Fax: 407-682-7180
Mailing address:
  • Phone: 407-682-7111
  • Fax: 407-682-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3676
License Number StateFL

VIII. Authorized Official

Name: MRS. LISA MENDOZA BEAURY
Title or Position: MNGR
Credential: D.O.M. / A.P.
Phone: 407-682-7111