Healthcare Provider Details

I. General information

NPI: 1922912674
Provider Name (Legal Business Name): BLISSFUL WELLNESS INTEGRATIVE MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 HERSCHEL ST
JACKSONVILLE FL
32204-3817
US

IV. Provider business mailing address

2065 HERSCHEL ST
JACKSONVILLE FL
32204-3817
US

V. Phone/Fax

Practice location:
  • Phone: 904-208-4040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELYSSA BLISSENBACH
Title or Position: PRESIDENT
Credential: MD
Phone: 904-387-3933