Healthcare Provider Details

I. General information

NPI: 1437067089
Provider Name (Legal Business Name): PURE PATH HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 24TH ST E
BRADENTON FL
34203-4940
US

IV. Provider business mailing address

7901 4TH ST NORTH #28537
ST PETERSBURG FL
33702
US

V. Phone/Fax

Practice location:
  • Phone: 941-301-6311
  • Fax: 833-764-5807
Mailing address:
  • Phone: 941-301-6311
  • Fax: 833-764-5807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALEA SOHN
Title or Position: OWNER
Credential: NP
Phone: 941-301-6311