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General NPI Number Information
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NPI Number | 1497695027
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Entity Type | Organization
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Legal Business Name | WELLNESS MANIFESTED HOLISTIC HEALTHCARE
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Dates
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Enumeration Date | 04/01/2026
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Last Update Date | 04/01/2026
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Provider Practice Location Address
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Address Line | 1226 DIXON BLVD
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City | COCOA
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State | FL
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Zip | 32922-4408
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Country | US
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Telephone | 321-223-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 515 DRYDEN CIR
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City | COCOA
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State | FL
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Zip | 32926-2487
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Country | US
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Telephone | 321-223-5513
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SHARON JONES
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Credential | APRN
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Telephone | 321-223-5513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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