Healthcare Provider Details

I. General information

NPI: 1487587556
Provider Name (Legal Business Name): PRUSSIAN BLUE HEALTH, WELLNESS AND FITNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 W ATLANTIC BLVD STE 101
MARGATE FL
33063-5157
US

IV. Provider business mailing address

6101 W ATLANTIC BLVD STE 101
MARGATE FL
33063-5157
US

V. Phone/Fax

Practice location:
  • Phone: 786-587-0915
  • Fax: 786-761-9231
Mailing address:
  • Phone: 786-587-0915
  • Fax: 786-761-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CARLA PETION
Title or Position: FAMILY NURSE PRACTITIONER
Credential: NP
Phone: 786-587-0915