Healthcare Provider Details

I. General information

NPI: 1285968008
Provider Name (Legal Business Name): ASCENSION WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11025 POND PINE DR
RIVERVIEW FL
33569-2235
US

IV. Provider business mailing address

11025 POND PINE DR
RIVERVIEW FL
33569-2235
US

V. Phone/Fax

Practice location:
  • Phone: 813-732-2108
  • Fax:
Mailing address:
  • Phone: 813-732-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP2707
License Number StateFL

VIII. Authorized Official

Name: MARK ABRAHAM
Title or Position: CEO
Credential: D.O.M.
Phone: 813-732-2108