Healthcare Provider Details

I. General information

NPI: 1649896804
Provider Name (Legal Business Name): TRICOCHE INTEGRATED HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 W HIBISCUS BLVD
MELBOURNE FL
32901-2622
US

IV. Provider business mailing address

1855 W HIBISCUS BLVD
MELBOURNE FL
32901-2622
US

V. Phone/Fax

Practice location:
  • Phone: 321-802-4521
  • Fax:
Mailing address:
  • Phone: 321-802-4521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN LEIGH LAURELLA
Title or Position: AM
Credential: APRN
Phone: 321-802-4521