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1114723541 NPI number — FLORIDIAN WELLNESS LLC

NPI Number: 1114723541
Health Care Provider/Practitioner: FLORIDIAN WELLNESS LLC

Information about “1114723541” NPI (FLORIDIAN WELLNESS LLC) exists in 1114723541 in HTML format HTML  |  1114723541 in plain Text format TXT  |  1114723541 in PDF (Portable Document Format) PDF  |  1114723541 in an XML format XML  formats.

NPI Number : 1114723541 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114723541",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FLORIDIAN WELLNESS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4400 W SAMPLE RD STE 240",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COCONUT CREEK",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33073-3473",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "954-591-7757",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4400 W SAMPLE RD STE 240",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COCONUT CREEK",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33073-3473",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "954-591-7757",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/25/2025",
    "LastUpdateDate": "04/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DELLA JACONO",
    "AuthorizedOfficialFirstName": "FRED",
    "AuthorizedOfficialMiddleName": "PATIRICK",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DC, AP, LMT",
    "AuthorizedOfficialTelephoneNumber": "954-591-7757",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "111N00000X",
          "TaxonomyName": "Chiropractor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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