Healthcare Provider Details

I. General information

NPI: 1184404451
Provider Name (Legal Business Name): IKIGAI HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11000 PROSPERITY FARMS RD STE 101B
PALM BEACH GARDENS FL
33410-3462
US

IV. Provider business mailing address

11000 PROSPERITY FARMS RD STE 101B
PALM BEACH GARDENS FL
33410-3462
US

V. Phone/Fax

Practice location:
  • Phone: 561-725-1661
  • Fax:
Mailing address:
  • Phone: 561-725-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS MARINO
Title or Position: MANAGER
Credential:
Phone: 772-919-5928