Healthcare Provider Details

I. General information

NPI: 1184956005
Provider Name (Legal Business Name): INTEGRATIVE HEALTHCARE & WELLNESS MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2658 MAGUIRE RD
OCOEE FL
34761-4752
US

IV. Provider business mailing address

511 PINEAPPLE CT
ORLANDO FL
32835-5309
US

V. Phone/Fax

Practice location:
  • Phone: 407-493-6873
  • Fax:
Mailing address:
  • Phone: 407-493-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2792
License Number StateFL

VIII. Authorized Official

Name: MS. ASHLEY S BOYER
Title or Position: CEO/PRES/ACUPUNCTURE PHYSICIAN
Credential: D.O.M., A.P.
Phone: 407-296-4566