Healthcare Provider Details

I. General information

NPI: 1316487069
Provider Name (Legal Business Name): 'OHANA HOLISTIC PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 MARBELLA CREEK AVE
TAMPA FL
33615-1234
US

IV. Provider business mailing address

7808 MARBELLA CREEK AVE
TAMPA FL
33615-1234
US

V. Phone/Fax

Practice location:
  • Phone: 813-352-8501
  • Fax:
Mailing address:
  • Phone: 813-352-8501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3489
License Number StateFL

VIII. Authorized Official

Name: MRS. JENNIFER MOLINARES-ARANGO
Title or Position: ACUPUNCTURE PHYSICIAN
Credential: A.P
Phone: 813-352-8501