Healthcare Provider Details

I. General information

NPI: 1972175529
Provider Name (Legal Business Name): NUVO WELLNESS & RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N HWY A1A STE 105
INDIALANTIC FL
32903-2736
US

IV. Provider business mailing address

1400 N HWY A1A STE 105
INDIALANTIC FL
32903-2736
US

V. Phone/Fax

Practice location:
  • Phone: 321-914-3381
  • Fax:
Mailing address:
  • Phone: 321-914-3381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DJUNOT DESTINA
Title or Position: OWNER
Credential:
Phone: 321-914-3381