Healthcare Provider Details

I. General information

NPI: 1609730654
Provider Name (Legal Business Name): MINDFUL HEART ORGANIZATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5897 LITTLE LEAF CT
MILTON FL
32570-3501
US

IV. Provider business mailing address

5897 LITTLE LEAF CT
MILTON FL
32570-3501
US

V. Phone/Fax

Practice location:
  • Phone: 850-490-7829
  • Fax: 850-304-0995
Mailing address:
  • Phone: 850-490-7829
  • Fax: 850-304-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MARC DANIEL WHITTLESAY JR.
Title or Position: OWNER
Credential:
Phone: 850-490-7829