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General NPI Number Information
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NPI Number | 1164731626
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Entity Type | Organization
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Legal Business Name | SUCCESS WITH NO LIMITS
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 948 N W 58TH COURT
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City | OCALA
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State | FL
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Zip | 34482
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Country | US
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Telephone | 352-401-7662
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Fax | 352-622-6315
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Provider Business Mailing Address
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Address Line | 948 NW 58TH CT
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City | OCALA
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State | FL
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Zip | 34482-5186
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Country | US
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Telephone | 352-401-7662
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Fax | 352-622-6315
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NIATIKQUA TIONSHAY GREEN
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Credential |
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Telephone | 352-401-7662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 000453000
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License Number State | FL
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