Healthcare Provider Details

I. General information

NPI: 1487510624
Provider Name (Legal Business Name): SAGE CENTER FOR INTEGRATIVE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ANCHOR RODE DR STE 304
NAPLES FL
34103-2751
US

IV. Provider business mailing address

801 ANCHOR RODE DR STE 304
NAPLES FL
34103-2751
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-9710
  • Fax: 239-294-3869
Mailing address:
  • Phone: 239-434-9710
  • Fax: 239-294-3869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOAQUIN HERNANDEZ
Title or Position: PROVIDER
Credential: ARNP
Phone: 239-434-9710