Healthcare Provider Details

I. General information

NPI: 1679490692
Provider Name (Legal Business Name): THE WHOLISTIC LOTUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 PARKBLUFF CIR
PONTE VEDRA FL
32081-0960
US

IV. Provider business mailing address

101 MARKETSIDE AVE STE 404-311
PONTE VEDRA FL
32081-1541
US

V. Phone/Fax

Practice location:
  • Phone: 904-297-8701
  • Fax:
Mailing address:
  • Phone: 904-297-8701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOANNA PENA
Title or Position: OWNER
Credential: DNP, APRN, FNP-C
Phone: 904-297-8701