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General NPI Number Information
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NPI Number | 1528926144
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Entity Type | Organization
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Legal Business Name | NOURIVIDA WELLNESS INC
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 1222 SE PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5364
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Country | US
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Telephone | 772-361-8448
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Fax | 772-492-4478
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Provider Business Mailing Address
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Address Line | 1222 SE PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-5364
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Country | US
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Telephone | 772-361-8448
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Fax | 772-492-4478
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Authorized Official
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Title or Position | CEO
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Name | YVETTE MCDONALD
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Credential | LCSW
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Telephone | 954-775-4248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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