Healthcare Provider Details

I. General information

NPI: 1134085442
Provider Name (Legal Business Name): INTEGRATIVE HEALTH PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 S FEDERAL HWY APT 211
POMPANO BEACH FL
33062-7545
US

IV. Provider business mailing address

1625 S FEDERAL HWY APT 211
POMPANO BEACH FL
33062-7545
US

V. Phone/Fax

Practice location:
  • Phone: 786-459-4864
  • Fax:
Mailing address:
  • Phone: 786-459-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY GREAVES
Title or Position: OWNER
Credential:
Phone: 786-459-4864