Healthcare Provider Details

I. General information

NPI: 1881418911
Provider Name (Legal Business Name): OCEAN PARK WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 ISABELLE AVE STE 6
PORT ORANGE FL
32127-6255
US

IV. Provider business mailing address

5656 ISABELLE AVE STE 6
PORT ORANGE FL
32127-6255
US

V. Phone/Fax

Practice location:
  • Phone: 386-847-9797
  • Fax:
Mailing address:
  • Phone: 386-847-9797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: DR. LANIKA BUCHANAN
Title or Position: PROVIDER
Credential: ND, AP
Phone: 386-847-9797