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General NPI Number Information
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NPI Number | 1093421794
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Entity Type | Organization
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Legal Business Name | TRANQUILITY HYDRATION WELLNESS AESTHETICS LLC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 218 N WALNUT CREEK DR
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City | MANSFIELD
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State | TX
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Zip | 76063-1755
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Country | US
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Telephone | 682-267-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 807 HONEY HOLLOW DR
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City | ARLINGTON
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State | TX
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Zip | 76002-3762
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Country | US
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Telephone | 682-267-3600
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | SADE BRISCOE
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Credential | FNP-C
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Telephone | 682-267-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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