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General NPI Number Information
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NPI Number | 1346006392
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Entity Type | Organization
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Legal Business Name | JB DIVINE WELLNESS LLC
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Dates
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Enumeration Date | 02/27/2024
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 9221 SUN TERRACE CIRCLE #D
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403
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Country | US
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Telephone | 561-677-0017
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Fax |
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Provider Business Mailing Address
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Address Line | 9221 SUN TERRACE CIRCLE #D
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33403
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Country | US
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Telephone | 561-677-0017
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANINE BEATTIE
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Credential | NP
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Telephone | 561-677-0017
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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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