Healthcare Provider Details

I. General information

NPI: 1528880499
Provider Name (Legal Business Name): THE CONCIERGE STYLIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GATLIN AVE STE 143
ORLANDO FL
32806-6950
US

IV. Provider business mailing address

1333 COLLEGE PKWY STE 1043
GULF BREEZE FL
32563-2711
US

V. Phone/Fax

Practice location:
  • Phone: 772-302-0191
  • Fax:
Mailing address:
  • Phone: 772-302-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIAN J TURNER
Title or Position: TRICHOLOGIST/ HAIR LOSS SPECIALIST
Credential:
Phone: 772-302-0191