Healthcare Provider Details

I. General information

NPI: 1619248275
Provider Name (Legal Business Name): TAVERNIER WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 10/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82913 OVERSEAS HWY
ISLAMORADA FL
33036-3638
US

IV. Provider business mailing address

101 OCEAN LN
ISLAMORADA FL
33036-3913
US

V. Phone/Fax

Practice location:
  • Phone: 305-394-0668
  • Fax:
Mailing address:
  • Phone: 305-394-0668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEFANIE H WOODS
Title or Position: OWNER
Credential: DOM, LMT
Phone: 305-394-0668