Healthcare Provider Details

I. General information

NPI: 1619785227
Provider Name (Legal Business Name): ESSENCE OF TIME HEALING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W SAMPLE RD STE 112
COCONUT CREEK FL
33073-3457
US

IV. Provider business mailing address

4400 W SAMPLE RD STE 112
COCONUT CREEK FL
33073-3457
US

V. Phone/Fax

Practice location:
  • Phone: 954-910-4651
  • Fax: 954-301-3814
Mailing address:
  • Phone: 954-910-4651
  • Fax: 954-301-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS SHAMEKA YVONNE TIME
Title or Position: MANAGER
Credential: ARNP
Phone: 954-910-4651