Healthcare Provider Details

I. General information

NPI: 1396565602
Provider Name (Legal Business Name): PERFORMANCE HYPERBARIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 NW FEDERAL HWY
STUART FL
34994-9303
US

IV. Provider business mailing address

1472 SE SUNSHINE AVE
PORT ST LUCIE FL
34952-6009
US

V. Phone/Fax

Practice location:
  • Phone: 347-427-5655
  • Fax:
Mailing address:
  • Phone: 347-427-5655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NIKOLAS MANGOLA
Title or Position: OWNER
Credential:
Phone: 347-427-5655