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General NPI Number Information
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NPI Number | 1497371108
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Entity Type | Organization
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Legal Business Name | GRACE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 2504 ACORN ST STE A
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City | FORT PIERCE
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State | FL
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Zip | 34947-4746
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Country | US
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Telephone | 772-837-7800
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Fax | 772-837-7801
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Provider Business Mailing Address
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Address Line | 2504 ACORN STREET STE A
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City | FORT PIERCE
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State | FL
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Zip | 34947
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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 | OWNER/PROVIDER
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Name | BARBIE BRUNET
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Credential | ARNP
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Telephone | 772-837-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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