Healthcare Provider Details

I. General information

NPI: 1487570271
Provider Name (Legal Business Name): AXE HOLISTIC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15049 BRUCE B DOWNS BLVD
TAMPA FL
33647-1388
US

IV. Provider business mailing address

15049 BRUCE B DOWNS BLVD
TAMPA FL
33647-1388
US

V. Phone/Fax

Practice location:
  • Phone: 813-563-7668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN AXE
Title or Position: CEO
Credential:
Phone: 937-216-9048