Healthcare Provider Details

I. General information

NPI: 1205428828
Provider Name (Legal Business Name): ENERGIZED HEALTH AND WELLBEING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 SAN MARCO AVE
ST AUGUSTINE FL
32084-3267
US

IV. Provider business mailing address

154 SAN MARCO AVE
ST AUGUSTINE FL
32084-3267
US

V. Phone/Fax

Practice location:
  • Phone: 904-429-1290
  • Fax: 904-429-1558
Mailing address:
  • Phone: 904-429-1290
  • Fax: 904-429-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ANN SPIES
Title or Position: OWNER
Credential: APRN
Phone: 904-429-1290