Healthcare Provider Details

I. General information

NPI: 1306590575
Provider Name (Legal Business Name): PURE BLISS FAMILY HEALTH NP AND RN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HILTON AVE STE 2
HEMPSTEAD NY
11550-8116
US

IV. Provider business mailing address

12049 PIONEERS WAY APT 2219
ORLANDO FL
32832-2811
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-9622
  • Fax: 201-643-6645
Mailing address:
  • Phone: 201-500-9622
  • Fax: 201-643-6645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMARA HENRY
Title or Position: FOUNDER
Credential:
Phone: 516-655-3684