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General NPI Number Information
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NPI Number | 1144836446
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Entity Type | Organization
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Legal Business Name | BELFIORE WELLNESS CENTER
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 502 E HICKORY AVE
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City | CRESTVIEW
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State | FL
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Zip | 32536-2742
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Country | US
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Telephone | 850-683-1100
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Fax | 850-683-0599
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Provider Business Mailing Address
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Address Line | 502 E HICKORY AVE
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City | CRESTVIEW
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State | FL
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Zip | 32536-2742
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Country | US
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Telephone | 850-683-1100
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Fax | 850-683-0599
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Authorized Official
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Title or Position | MBR
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Name | KRISTINA SMITH
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Credential | APRN
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Telephone | 256-677-3295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | 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 | 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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