Healthcare Provider Details

I. General information

NPI: 1588382329
Provider Name (Legal Business Name): S & V BARE ESSENTIALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SW 17TH ST UNIT C
OCALA FL
34471-8138
US

IV. Provider business mailing address

202 SW 17TH ST UNIT C
OCALA FL
34471-8138
US

V. Phone/Fax

Practice location:
  • Phone: 352-877-8700
  • Fax: 352-608-9718
Mailing address:
  • Phone: 352-877-8700
  • Fax: 352-608-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State

VIII. Authorized Official

Name: SANDRA BROWN
Title or Position: OWNER
Credential: CFM
Phone: 352-877-8700