Healthcare Provider Details

I. General information

NPI: 1386569044
Provider Name (Legal Business Name): H2O AESTHETICS AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 BOULEVARD
COLONIAL HEIGHTS VA
23834-1415
US

IV. Provider business mailing address

PO BOX 1020
COLONIAL HEIGHTS VA
23834-1020
US

V. Phone/Fax

Practice location:
  • Phone: 833-575-4562
  • Fax: 804-207-8912
Mailing address:
  • Phone: 833-575-4562
  • Fax: 804-207-8912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JUDY HALE
Title or Position: OWNER
Credential:
Phone: 833-575-4562