Healthcare Provider Details

I. General information

NPI: 1790549384
Provider Name (Legal Business Name): SERENITY MEDICAL HOUSE CALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7231 CHAD CT
OKAHUMPKA FL
34762-6647
US

IV. Provider business mailing address

7231 CHAD CT
OKAHUMPKA FL
34762-6647
US

V. Phone/Fax

Practice location:
  • Phone: 856-669-8488
  • Fax: 352-321-4247
Mailing address:
  • Phone: 856-669-8488
  • Fax: 352-321-4247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MESHELL MANSOR
Title or Position: OWNER
Credential:
Phone: 856-669-8488