Healthcare Provider Details

I. General information

NPI: 1093107518
Provider Name (Legal Business Name): HILTON HOLISTIC HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 2ND ST S STE A
SAFETY HARBOR FL
34695-4014
US

IV. Provider business mailing address

405 2ND ST S STE A
SAFETY HARBOR FL
34695-4014
US

V. Phone/Fax

Practice location:
  • Phone: 727-433-8314
  • Fax:
Mailing address:
  • Phone: 727-433-8314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3619
License Number StateFL

VIII. Authorized Official

Name: DE'NICEA HILTON
Title or Position: DOM, AP, CEO/CMO
Credential: DOM, AP
Phone: 813-625-0178