Healthcare Provider Details

I. General information

NPI: 1851663199
Provider Name (Legal Business Name): CREATIVE HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 OVERLOOK DR
WINTER HAVEN FL
33884-1600
US

IV. Provider business mailing address

102 OVERLOOK DR
WINTER HAVEN FL
33884-1600
US

V. Phone/Fax

Practice location:
  • Phone: 863-370-5142
  • Fax:
Mailing address:
  • Phone: 863-370-5142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberOTA7656
License Number StateFL

VIII. Authorized Official

Name: MRS. SHANNON SPRINKLE
Title or Position: MANAGER
Credential:
Phone: 765-465-3203