Healthcare Provider Details

I. General information

NPI: 1851189260
Provider Name (Legal Business Name): GLOWTOX STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 SW MARTIN DOWNS BLVD STE 200
PALM CITY FL
34990-2680
US

IV. Provider business mailing address

1914 SW NOTRE DAME AVE
PORT ST LUCIE FL
34953-2469
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-0620
  • Fax: 772-223-0640
Mailing address:
  • Phone: 305-979-7195
  • Fax: 262-425-8964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUIS ENRIQUE MORERA
Title or Position: AUTHORIZED OFFICIAL
Credential: APRN
Phone: 305-979-7195