=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538025747
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE WAVE CONCIERGE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2025
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10778 SE FEDERAL HWY
-----------------------------------------------------
City | HOBE SOUND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33455-4922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-906-7829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10778 SE FEDERAL HWY
-----------------------------------------------------
City | HOBE SOUND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33455-4922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-906-7829
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WESLEY STEWART
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 336-906-7829
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------