Healthcare Provider Details

I. General information

NPI: 1912635392
Provider Name (Legal Business Name): TONISE FLOREXIL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 NORTHLAKE BLVD STE 214-127
WEST PALM BEACH FL
33412-1101
US

IV. Provider business mailing address

10705 LA STRADA
WEST PALM BEACH FL
33412-3037
US

V. Phone/Fax

Practice location:
  • Phone: 561-455-6826
  • Fax:
Mailing address:
  • Phone: 561-455-6826
  • Fax: 561-530-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY11507
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: