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General NPI Number Information
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NPI Number | 1518779115
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Entity Type | Organization
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Legal Business Name | VITAMINISE WELLNEST CLINIC
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 9753 S ORANGE BLOSSOM TRL STE 101
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City | ORLANDO
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State | FL
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Zip | 32837-8998
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Country | US
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Telephone | 689-310-2613
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Fax | 407-386-3220
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Provider Business Mailing Address
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Address Line | ELIZABETH.HENSON@WELLNESTHCC.COM 437 PANDA PL
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City | DAVENPORT
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State | FL
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Zip | 33837
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Country | US
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Telephone | 689-310-3310
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Fax | 407-386-3220
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ELIZABETH HENSON
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Credential | APRN
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Telephone | 689-310-3313
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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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