Healthcare Provider Details

I. General information

NPI: 1437763208
Provider Name (Legal Business Name): NU MIND BODY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 N MAITLAND AVE STE C3
MAITLAND FL
32751-4754
US

IV. Provider business mailing address

10524 MOSS PARK RD STE 204
ORLANDO FL
32832-5801
US

V. Phone/Fax

Practice location:
  • Phone: 951-468-6463
  • Fax: 920-696-8797
Mailing address:
  • Phone: 951-468-6463
  • Fax: 920-696-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NU MIND BODY HEALTH
Title or Position: APRN
Credential: DNP, APRN
Phone: 951-468-6463