Healthcare Provider Details

I. General information

NPI: 1750817722
Provider Name (Legal Business Name): PRAXIS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 RIGSBY LN STE 100
SAFETY HARBOR FL
34695-4831
US

IV. Provider business mailing address

2905 RIGSBY LN STE 100
SAFETY HARBOR FL
34695-4831
US

V. Phone/Fax

Practice location:
  • Phone: 727-314-2130
  • Fax: 855-933-2590
Mailing address:
  • Phone: 727-314-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: ANNE M LIMA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 727-314-2130