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General NPI Number Information
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NPI Number | 1457110264
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Entity Type | Organization
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Legal Business Name | BLACK HEARTS GALLERY
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Dates
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Enumeration Date | 03/14/2024
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 801 W SR 436
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3054
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Country | US
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Telephone | 954-593-4675
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Fax |
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Provider Business Mailing Address
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Address Line | 1177 WOODS LANDING DR
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City | MINNEOLA
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State | FL
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Zip | 34715-6067
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JENNIFER RAMIREZ
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Credential | APRN
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Telephone | 954-593-4675
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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