Healthcare Provider Details

I. General information

NPI: 1679603211
Provider Name (Legal Business Name): SERENITY WELL BEING CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 MEASE DR SUITE 315
SAFETY HARBOR FL
34695-6602
US

IV. Provider business mailing address

36181 E LAKE RD SUITE 55
PALM HARBOR FL
34685-3142
US

V. Phone/Fax

Practice location:
  • Phone: 727-631-1592
  • Fax:
Mailing address:
  • Phone: 727-631-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO3060
License Number StateFL

VIII. Authorized Official

Name: DR. NAZANIN ROBOUBI
Title or Position: PODIATRIST
Credential: DPM
Phone: 727-631-1592