Healthcare Provider Details

I. General information

NPI: 1629327465
Provider Name (Legal Business Name): BOCA WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17340 BOCA CLUB BLVD SUITE 703
BOCA RATON FL
33487-1024
US

IV. Provider business mailing address

17340 BOCA CLUB BLVD SUITE 703
BOCA RATON FL
33487-1024
US

V. Phone/Fax

Practice location:
  • Phone: 954-328-9124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: KAREN NOVEK REYNOLDS
Title or Position: PRESIDENT
Credential:
Phone: 954-328-9124