Healthcare Provider Details

I. General information

NPI: 1679488621
Provider Name (Legal Business Name): INNOVAHEAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 SW 141ST TER
DAVIE FL
33330-4678
US

IV. Provider business mailing address

3023 SW 141ST TER
DAVIE FL
33330-4678
US

V. Phone/Fax

Practice location:
  • Phone: 954-647-4259
  • Fax: 954-647-4259
Mailing address:
  • Phone: 954-647-4259
  • Fax: 954-647-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL PATRICK LYNCH
Title or Position: MANAGER
Credential:
Phone: 954-647-4259