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General NPI Number Information
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NPI Number | 1043803133
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Entity Type | Organization
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Legal Business Name | ONE BEAUTIFUL MIND L.L.C.
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Dates
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Enumeration Date | 02/19/2021
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 1317 EDGEWATER DR # 1973
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City | ORLANDO
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State | FL
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Zip | 32804-6350
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Country | US
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Telephone | 407-254-7593
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Fax |
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Provider Business Mailing Address
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Address Line | 1232 TALLOW RD
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City | APOPKA
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State | FL
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Zip | 32703-8443
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Country | US
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Telephone | 407-247-4772
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANITA MARTIN
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Credential | APRN
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Telephone | 407-247-4772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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