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General NPI Number Information
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NPI Number | 1366956518
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Entity Type | Organization
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Legal Business Name | BODY & SOLE WELLNESS, LLC
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 8585 SUNSET DR STE 103
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City | MIAMI
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State | FL
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Zip | 33143-3753
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Country | US
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Telephone | 954-243-9946
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Fax |
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Provider Business Mailing Address
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Address Line | 9640 NW 10TH CT
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City | PLANTATION
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State | FL
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Zip | 33322-4851
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Country | US
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Telephone | 954-243-9946
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YANA NICOLE BLAISE
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Credential | ARNP, DNP
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Telephone | 954-243-9946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9279753
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License Number State | FL
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