Healthcare Provider Details

I. General information

NPI: 1508772120
Provider Name (Legal Business Name): LUMINATE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N # 35542
ST PETERSBURG FL
33702-4305
US

IV. Provider business mailing address

7901 4TH ST N STE 35542
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 352-646-2511
  • Fax: 352-646-2511
Mailing address:
  • Phone: 352-646-2511
  • Fax: 386-204-7354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANISA RENEE NOEL
Title or Position: OWNER
Credential: APRN
Phone: 813-716-3995