Healthcare Provider Details

I. General information

NPI: 1831601426
Provider Name (Legal Business Name): JUST FOR LADIES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 HIGHLAND MANOR DR STE 200
TAMPA FL
33610-9712
US

IV. Provider business mailing address

PO BOX 89655
TAMPA FL
33689-0410
US

V. Phone/Fax

Practice location:
  • Phone: 813-361-2138
  • Fax:
Mailing address:
  • Phone: 813-361-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name: MRS. VICKIE WALTERS-NUNN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: BACHELORS OF SCIENCE
Phone: 813-361-2138