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General NPI Number Information
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NPI Number | 1225909377
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Entity Type | Organization
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Legal Business Name | MB COMMUNITY WELLNESS PROVIDER LLC
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 885 33RD AVE
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City | VERO BEACH
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State | FL
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Zip | 32960-4090
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Country | US
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Telephone | 772-047-3726
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Fax |
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Provider Business Mailing Address
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Address Line | 885 33RD AVE
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City | VERO BEACH
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State | FL
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Zip | 32960-4090
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Country | US
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Telephone | 772-047-3726
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | AL BERRY
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Credential |
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Telephone | 469-915-4211
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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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