Healthcare Provider Details

I. General information

NPI: 1689964199
Provider Name (Legal Business Name): VREELAND ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 A1A S SUITE 104
SAINT AUGUSTINE FL
32080-6591
US

IV. Provider business mailing address

PO BOX 840283
SAINT AUGUSTINE FL
32080-0283
US

V. Phone/Fax

Practice location:
  • Phone: 904-814-4323
  • Fax:
Mailing address:
  • Phone: 904-814-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MIMI VREELAND
Title or Position: ACUPUNCTURE PHYSICIAN
Credential: AP
Phone: 904-814-4323