Healthcare Provider Details

I. General information

NPI: 1316841042
Provider Name (Legal Business Name): LUXXE WEIGHT LOSS AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5991 CHESTER AVE STE 102
JACKSONVILLE FL
32217-2265
US

IV. Provider business mailing address

5991 CHESTER AVE STE 102
JACKSONVILLE FL
32217-2265
US

V. Phone/Fax

Practice location:
  • Phone: 904-299-2709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: VANQUIECE SMITH
Title or Position: OPERATION MANAGER
Credential: NP
Phone: 850-737-9214