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General NPI Number Information
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NPI Number | 1437973427
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Entity Type | Organization
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Legal Business Name | ABUNDANT HARVEST HEALTH AND HEALING, LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 1015 GOLDEN SHINER AVE
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City | RUSKIN
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State | FL
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Zip | 33570-3309
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Country | US
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Telephone | 727-342-0209
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 34TH ST S # 449
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City | ST PETERSBURG
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State | FL
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Zip | 33711-4511
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Country | US
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Telephone | 727-342-0209
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. BONITA J CLARK
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Credential | APRN-FNP
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Telephone | 727-342-0209
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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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