Healthcare Provider Details

I. General information

NPI: 1659208932
Provider Name (Legal Business Name): BODY & MIND HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 WASHINGTON AVE APT 457
BELLEVILLE NJ
07109-2820
US

IV. Provider business mailing address

630 WASHINGTON AVE APT 457
BELLEVILLE NJ
07109-2820
US

V. Phone/Fax

Practice location:
  • Phone: 309-916-8527
  • Fax: 201-720-0401
Mailing address:
  • Phone: 309-916-8527
  • Fax: 201-720-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: YOHAN HERNANDEZ FLORES
Title or Position: MANAGER
Credential: APN
Phone: 309-916-8527