Healthcare Provider Details

I. General information

NPI: 1861172207
Provider Name (Legal Business Name): HYPERBARIC HAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12794 FOREST HILL BLVD STE 9-10
WELLINGTON FL
33414-4710
US

IV. Provider business mailing address

12794 FOREST HILL BLVD STE 9-10
WELLINGTON FL
33414-4710
US

V. Phone/Fax

Practice location:
  • Phone: 954-592-4961
  • Fax:
Mailing address:
  • Phone: 954-592-4961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY MCCALLA
Title or Position: OWNER
Credential:
Phone: 954-592-4961