Healthcare Provider Details

I. General information

NPI: 1962367219
Provider Name (Legal Business Name): MAISON CURA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N CAUSEWAY
NEW SMYRNA BEACH FL
32169-5239
US

IV. Provider business mailing address

223 N CAUSEWAY
NEW SMYRNA BEACH FL
32169-5239
US

V. Phone/Fax

Practice location:
  • Phone: 386-308-5088
  • Fax: 386-308-5089
Mailing address:
  • Phone: 386-308-5088
  • Fax: 386-308-5089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLI NICOLE BRIDGMAN
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 386-308-5088