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General NPI Number Information
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NPI Number | 1336811272
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Entity Type | Organization
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Legal Business Name | QUICK START WEIGHT LOSS & WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 4577 WATKINS ST
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City | PACE
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State | FL
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Zip | 32571-2511
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Country | US
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Telephone | 850-910-4021
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Fax |
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Provider Business Mailing Address
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Address Line | 5264 EMERALD DR
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City | PACE
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State | FL
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Zip | 32571-9067
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Country | US
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Telephone | 850-816-8889
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURA MAUPIN
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Credential |
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Telephone | 850-910-4021
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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