Healthcare Provider Details

I. General information

NPI: 1629943311
Provider Name (Legal Business Name): MOXIE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12515 ORANGE DR STE 803
DAVIE FL
33330-4309
US

IV. Provider business mailing address

12515 ORANGE DR STE 803
DAVIE FL
33330-4309
US

V. Phone/Fax

Practice location:
  • Phone: 786-975-6993
  • Fax: 954-405-8541
Mailing address:
  • Phone: 786-975-6993
  • Fax: 954-405-8541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YULEISY COTO
Title or Position: APRN/OWNER
Credential: FNP-C
Phone: 786-975-6993