Healthcare Provider Details

I. General information

NPI: 1295662534
Provider Name (Legal Business Name): INTENTIONAL HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8342 OLD FOREST RD
PALM BCH GDNS FL
33410-6390
US

IV. Provider business mailing address

8342 OLD FOREST RD
PALM BCH GDNS FL
33410-6390
US

V. Phone/Fax

Practice location:
  • Phone: 561-704-4779
  • Fax:
Mailing address:
  • Phone: 561-704-4779
  • Fax:

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: MS. PATRICIA ANN WHALEN
Title or Position: OWNER
Credential: APRN-C
Phone: 561-704-4779