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General NPI Number Information
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NPI Number | 1508772120
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Entity Type | Organization
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Legal Business Name | LUMINATE HEALTH, LLC
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Dates
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Enumeration Date | 08/22/2026
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Last Update Date | 08/22/2026
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Provider Practice Location Address
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Address Line | 487 NE 250TH AVE
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City | OLD TOWN
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State | FL
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Zip | 32680-3033
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Country | US
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Telephone | 352-646-2511
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Fax | 352-646-2511
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone | 352-646-2511
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Fax | 386-204-7354
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JANISA RENEE NOEL
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Credential | APRN
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Telephone | 352-646-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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