Healthcare Provider Details

I. General information

NPI: 1144836446
Provider Name (Legal Business Name): BELFIORE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E HICKORY AVE
CRESTVIEW FL
32536-2742
US

IV. Provider business mailing address

502 E HICKORY AVE
CRESTVIEW FL
32536-2742
US

V. Phone/Fax

Practice location:
  • Phone: 850-683-1100
  • Fax: 850-683-0599
Mailing address:
  • Phone: 850-683-1100
  • Fax: 850-683-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA SMITH
Title or Position: AMBR
Credential: NP
Phone: 850-683-1100