Healthcare Provider Details

I. General information

NPI: 1740992072
Provider Name (Legal Business Name): ZEN MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SE DIXIE HWY
STUART FL
34994-3045
US

IV. Provider business mailing address

520 SE DIXIE HWY
STUART FL
34994-3045
US

V. Phone/Fax

Practice location:
  • Phone: 772-888-2830
  • Fax:
Mailing address:
  • Phone: 772-888-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE O'CONNOR
Title or Position: OWNER
Credential:
Phone: 772-888-2830